So-Young Shin1, Joong-Il Park2, Sue K Park3, Elizabeth Barrett-Connor4. 1. Epidemiology Division, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, United States; Regional Medical Affairs Women's HealthCare, Bayer HealthCare Pharmaceuticals, Seoul, Republic of Korea. 2. Cardiology Division, Internal Medicine, Veterans Health Service Medical Center, Seoul, Republic of Korea. 3. Epidemiology Division, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, United States; Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea. 4. Epidemiology Division, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, United States. Electronic address: ebarrettconnor@ucsd.edu.
Abstract
BACKGROUND: Exercise electrocardiography in asymptomatic adults has been criticized because of relatively poor accuracy predicting future heart disease risk, but studies may have been too short. We investigated if integrated analysis of graded exercise tolerance tests (GXT) predicted long-term coronary heart disease (CHD) and all-cause mortalities among community-dwelling older adults. METHODS AND RESULTS: From 1972 to 1974, 1789 adult residents of a predominantly Caucasian, middle- to upper-middle-class southern California community participated in a clinical evaluation that included a GXT; 52.4% (N=939) of those who had baseline GXT were followed up to 2010-up to 36years-for vital status, CHD and all-cause mortality. Multiply adjusted hazard ratios of an abnormal graded GXT were 1.65 (95% CI 0.78-3.49) and 1.56 (95% CI 1.15-2.11) for CHD and all-cause mortality, respectively. An integrated analysis hazard ratio was calculated based on the following GXT findings: significant ST change, inability to achieve target heart rate [THR], abnormal heart rate recovery [HRR], and chronotropic incompetency [ChI]. Compared to those with 0 or 1 abnormality, participants with 2 or more positive findings had significantly higher CHD (HR 2.18) and all-cause (HR 1.92) mortalities. Participants with 3 or more positive findings showed even higher hazard ratios-CHD (HR 6.16) and all-cause (HR 2.49) mortalities. When adjusted for any of 3 Framingham risk models, the integrated electrocardiographic model correlated well with CHD and all-cause mortalities. CONCLUSIONS: An integrated analysis of electrocardiographic and non-electrocardiographic measures of GXT is useful in predicting long-term CHD and all-cause mortalities in an asymptomatic middle-aged population.
BACKGROUND: Exercise electrocardiography in asymptomatic adults has been criticized because of relatively poor accuracy predicting future heart disease risk, but studies may have been too short. We investigated if integrated analysis of graded exercise tolerance tests (GXT) predicted long-term coronary heart disease (CHD) and all-cause mortalities among community-dwelling older adults. METHODS AND RESULTS: From 1972 to 1974, 1789 adult residents of a predominantly Caucasian, middle- to upper-middle-class southern California community participated in a clinical evaluation that included a GXT; 52.4% (N=939) of those who had baseline GXT were followed up to 2010-up to 36years-for vital status, CHD and all-cause mortality. Multiply adjusted hazard ratios of an abnormal graded GXT were 1.65 (95% CI 0.78-3.49) and 1.56 (95% CI 1.15-2.11) for CHD and all-cause mortality, respectively. An integrated analysis hazard ratio was calculated based on the following GXT findings: significant ST change, inability to achieve target heart rate [THR], abnormal heart rate recovery [HRR], and chronotropic incompetency [ChI]. Compared to those with 0 or 1 abnormality, participants with 2 or more positive findings had significantly higher CHD (HR 2.18) and all-cause (HR 1.92) mortalities. Participants with 3 or more positive findings showed even higher hazard ratios-CHD (HR 6.16) and all-cause (HR 2.49) mortalities. When adjusted for any of 3 Framingham risk models, the integrated electrocardiographic model correlated well with CHD and all-cause mortalities. CONCLUSIONS: An integrated analysis of electrocardiographic and non-electrocardiographic measures of GXT is useful in predicting long-term CHD and all-cause mortalities in an asymptomatic middle-aged population.
Authors: Babak Azarbal; Sean W Hayes; Howard C Lewin; Rory Hachamovitch; Ishac Cohen; Daniel S Berman Journal: J Am Coll Cardiol Date: 2004-07-21 Impact factor: 24.094
Authors: E Giagnoni; M B Secchi; S C Wu; A Morabito; L Oltrona; S Mancarella; N Volpin; L Fossa; L Bettazzi; G Arangio; A Sachero; G Folli Journal: N Engl J Med Date: 1983-11-03 Impact factor: 91.245
Authors: D J Gordon; L G Ekelund; J M Karon; J L Probstfield; C Rubenstein; L T Sheffield; L Weissfeld Journal: Circulation Date: 1986-08 Impact factor: 29.690
Authors: K Imai; H Sato; M Hori; H Kusuoka; H Ozaki; H Yokoyama; H Takeda; M Inoue; T Kamada Journal: J Am Coll Cardiol Date: 1994-11-15 Impact factor: 24.094
Authors: P M Rautaharju; R J Prineas; W J Eifler; C D Furberg; J D Neaton; R S Crow; J Stamler; J A Cutler Journal: J Am Coll Cardiol Date: 1986-07 Impact factor: 24.094