Maximal Exercise Electrocardiography Responses and Coronary Heart Disease Mortality Among Men With Diabetes Mellitus

Lyerly, G. William; Sui, Xuemei; Church, Timothy S.; Lavie, Carl J.; Hand, Gregory A.; Blair, Steven N.

doi:10.1161/circulationaha.107.729277

Cited by 40 publications

(28 citation statements)

References 32 publications

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“…We also found that men with higher CRF levels had higher survival rates when compared with unfit men and that abnormal E-ECG test results were associated with an increased risk of all-cause mortality. 4,25,26 Our current results further strengthen the prognostic power of E-ECG testing in men with MetS.…”

Section: Discussionsupporting

confidence: 72%

“…Our results suggested that equivocal and abnormal E-ECG responses were associated with higher risk of all-cause, CVD, and CHD mortality. 4 In previous studies, exercise testing has been shown to be an important predictor of survival. 4, 24 Prakash et al 24 found that abnormal E-ECG test results were significantly more common in those who died during the follow-up, and exercise capacity (<5 METs) was independently and significantly associated with all-cause mortality.…”

Section: Discussionmentioning

confidence: 98%

“…4 In previous studies, exercise testing has been shown to be an important predictor of survival. 4, 24 Prakash et al 24 found that abnormal E-ECG test results were significantly more common in those who died during the follow-up, and exercise capacity (<5 METs) was independently and significantly associated with all-cause mortality. We also found that men with higher CRF levels had higher survival rates when compared with unfit men and that abnormal E-ECG test results were associated with an increased risk of all-cause mortality.…”

Section: Discussionmentioning

confidence: 98%

“…All stress tests conducted were maximal tests, and all ECGs were 12-lead and continually monitored for 10 minutes after the conclusion of each test. 4,11,14 The use of this extensive monitoring ensured that we would capture most, if not all, abnormalities that may have occurred.…”

Section: Discussionmentioning

confidence: 99%

“…4 Thus, although DM is considered a CHD risk equivalent, important additional information for risk stratification can be obtained from exercise testing. We also showed that exercise testing can be used to identify women with impaired fasting glucose, a predecessor to DM and MetS, who are at high risk of all-cause mortality.…”

mentioning

confidence: 99%

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Maximal Exercise Electrocardiographic Responses and Coronary Heart Disease Mortality Among Men With Metabolic Syndrome

Lyerly

Sui²,

Church

et al. 2010

Mayo Clinic Proceedings

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Objective: To examine the association between abnormal exercise electrocardiographic (E-ECG) test results and mortality (all-cause and that resulting from coronary heart disease [CHD] or cardiovascular disease [CVD]) in a large population of asymptomatic men with metabolic syndrome (MetS).patients and MethOds: A total of 9191 men (mean age, 46.9 years) met the criteria of having MetS. All completed a maximal E-ECG treadmill test (May 14, 1979, through April 9, 2001) and were without a previous CVD event or diabetes at baseline. Main outcomes were all-cause mortality, mortality due to CHD, and mortality due to CVD. Cox regression analysis was used to quantify the mortality risk according to E-ECG responses.Results: During a follow-up of 14 years, 633 deaths (242 CVD and 150 CHD) were identified. Mortality rates and hazard ratios (HRs) across E-ECG responses were the following: for all-cause mortality: HR, 1.36; 95% confidence interval (CI), 1.09-1.70 for equivocal responses and HR, 1.41; 95% CI, 1.12-1.77 for abnormal responses (P trend <.001); for mortality due to CVD: HR, 1.29; 95% CI, 0.88-1.88 for equivocal responses and HR, 2.04; 95% CI, 1.46-2.84 for abnormal responses (P trend <.001); and for mortality due to CHD: HR, 1.62; 95% CI, 1.02-2.56 for equivocal responses and HR, 2.45; 95% CI, 1.62-3.69 for abnormal responses (P trend <.001). A positive gradient for CHD, CVD, and all-cause mortality rates across E-ECG categories within 3, 4, or 5 MetS components was observed (P<.001 for all).cOnclusiOn: Among men with MetS, an abnormal E-ECG response was associated with higher risk of all-cause, CVD, and CHD mortality. These findings underscore the importance of E-ECG tests to identify men with MetS who are at risk of dying. Proc. 2010;85(3):239-246 ACLS = Aerobics Center Longitudinal Study; CHD = coronary heart disease; CI = confidence interval; CRF = cardiorespiratory fitness; CVD = cardiovascular disease; DM = diabetes mellitus; ECG = electrocardiography; E-ECG = exercise ECG; HR = hazard ratio; MET = metabolic equivalent; MetS = metabolic syndrome; NDI = National Death Index; SRI = stress-recovery index From the department of Kinesiology, school of health, Kinesiology, and sport studies, coastal carolina university, conway, sc (G.W.l.); department of exercise science (G.W.l., X.s., G.a.h., s.n.b.) and department of epidemiology and biostatistics (s.n.b.), arnold school of public health, university of south carolina, columbia; pennington biomedical Research center, baton Rouge, la (t.s.c.); and department of cardiovascular diseases, Ochsner Medical center, new Orleans, la (c.j.l.). the aerobics center longitudinal study was supported by national institutes of health grants aG06945 and hl62508. Mayo Clinindividual reprints of this article are not available. address correspondence to G. William lyerly, phd, department of Kinesiology, school of health, Kinesiology, and sport studies, coastal carolina university, pO box 261954, conway, sc 29528 (glyerly@coastal.edu). © 2010 Mayo Foundation for Medical Education ...

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Maximal Exercise Electrocardiographic Responses and Coronary Heart Disease Mortality Among Men With Metabolic Syndrome

Lyerly

Sui²,

Church

et al. 2010

Mayo Clinic Proceedings

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Diagnostic and prognostic testing to evaluate coronary artery disease in patients with diabetes mellitus

Patel

Balady

2010

Rev Endocr Metab Disord

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Coronary artery disease (CAD) continues to be the most common cause of morbidity and mortality in patients with diabetes mellitus (DM). In recent years, the strategies for treatment of CAD in DM have undergone much evolution. Currently, all patients with DM, regardless of symptoms or diagnosed CAD, are treated aggressively for CAD risk factor reduction. In this clinical climate, the ability to specifically identify patients with disease that will benefit from more aggressive and invasive therapies remains a challenge. In this article we review the current literature on diagnostic and prognostic utility of conventional non-invasive modalities for assessment of CAD in patients with DM, as well as on novel and emerging methods for CAD risk stratification.

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Exercise Stress Testing

Chaitman¹

2012

Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine

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Maximal Exercise Electrocardiography Responses and Coronary Heart Disease Mortality Among Men With Diabetes Mellitus

Abstract: Background-An abnormal ECG during maximal exercise testing has been shown to be a powerful predictor of future coronary heart disease (CHD) mortality in asymptomatic men.

Cited by 40 publications

References 32 publications

Maximal Exercise Electrocardiographic Responses and Coronary Heart Disease Mortality Among Men With Metabolic Syndrome

Maximal Exercise Electrocardiographic Responses and Coronary Heart Disease Mortality Among Men With Metabolic Syndrome

Diagnostic and prognostic testing to evaluate coronary artery disease in patients with diabetes mellitus

Exercise Stress Testing

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