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Background  Associations of atherosclerosis risk factors with unrecognized myocardial infarction ( UMI ) are unclear. We investigated associations of midlife risk factors with  UMI  and recognized  MI  ( RMI ) detected 31 years later by cardiac magnetic resonance.    Methods and Results  The Reykjavik Study (1967–1991) collected serial risk factors in subjects, mean ( SD ) age 48 (7) years. In  ICELAND ‐ MI  (2004–2007), 936 survivors (76 (5) years) were evaluated by cardiac magnetic resonance. Analysis included logistic regression and random effects modeling. Comparisons are relative to subjects without  MI . At baseline midlife evaluation, a modified Framingham risk score was significantly higher in  RMI  and in  UMI  versus no  MI  (7.4 (6.3)%; 7.1 (6.2)% versus 5.4 (5.8)%,  P <0.001).  RMI  and  UMI  were more frequent in men (65%, 64% versus 43%;  P <0.0001). Baseline systolic and diastolic blood pressure were significantly higher in  UMI  (138 (17) mm Hg versus 133 (17) mm Hg;  P <0.006; 87 (10) mm Hg versus 84 (10) mm Hg;  P <0.02). Diastolic  BP  was significantly higher in  RMI  (88 (10) mm Hg versus 84 (10) mm Hg;  P <0.02). Cholesterol and triglycerides were significantly higher in  RMI  (6.7 (1.1) mmol/L versus 6.2 (1.1) mmol/L;  P =0.0005; and 1.4 (0.7) mmol/L versus 1.1 (0.7) mmol/L;  P <0.003). Cholesterol trended higher in  UMI  ( P =0.08). Serial midlife systolic  BP  was significantly higher in  UMI  versus no  MI  (β [ SE ] = 2.69 [1.28] mm Hg,  P =0.04). Serial systolic and diastolic  BP  were significantly higher in  RMI  versus no  MI  (4.12 [1.60] mm Hg,  P =0.01 and 2.05 [0.91] mm Hg,  P =0.03) as were cholesterol (0.43 [0.11] mmol/L,  P =0.0001) and triglycerides (0.3 [0.06] mmol/L,  P <0.0001).    Conclusions  Midlife vascular risk factors are associated with  UMI  and  RMI  detected by cardiac magnetic resonance 31 years later. Systolic blood pressure was the most significant modifiable risk factor associated with later  UMI .

journal of the american heart association

Midlife Cardiovascular Risk Factors and Late‐Life Unrecognized and Recognized Myocardial Infarction Detect by Cardiac Magnetic Resonance:  ICELAND ‐ MI , the  AGES ‐Reykjavik Study