Role of nondiagnostic exercise-induced ST-segment abnormalities in predicting future coronary events in asymptomatic volunteers

Rywik, Tomasz; O’Connor, F.C.; Gittings, Neil S.; Wright, J.G.; Khan, Anjum; Fleg, Jerome L.

doi:10.1016/s1062-1458(03)00051-5

Cited by 10 publications

(12 citation statements)

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“…Unfortunately, the clinical usefulness of these data is limited, because the exercise test variables were analyzed as a composite rather than separately. In another study of 1083 asymptomatic subjects (mean age, 52 years), Rywik et al 10 demonstrated that Ն1-mm horizontal or downsloping STsegment depression during treadmill exercise testing yielded an odds ratio of 2.7 for the occurrence of CHD events (angina, myocardial infarction, death) when controlled for age, sex, and cholesterol level.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Exercise Testing in the Prediction of Coronary Disease Risk Among Asymptomatic Persons as a Function of the Framingham Risk Score

et al. 2004

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Background-The purpose of this study is to determine the usefulness of exercise treadmill testing (ETT) among asymptomatic persons in predicting coronary heart disease (CHD) events over and above the Framingham CHD risk score. Methods and Results-Subjects included 3043 members of the Framingham Heart Study offspring cohort without CHD (1431 men and 1612 women; age, 45Ϯ9 years) who underwent ETT and were followed up for 18.2 years. The risk of developing CHD was evaluated relative to 3 exercise test variables: (1) ST-segment depression Ն1 mm, (2) failure to achieve target heart rate (THR) of 85% predicted maximum, and (3) exercise capacity. In multivariable analyses that adjusted for age and Framingham CHD risk score, among men, ST-segment depression (hazard ratio [HR], 1.88; 95% CI, 1.21 to 2.91) and failure to achieve THR (HR, 1.70; 95% CI, 1.18 to 2.45) predicted higher CHD risk, whereas a greater exercise capacity predicted lower CHD risk (HR per MET, 0.94; 95% CI, 0.89 to 0.99). Although similar HRs were seen in women, those results were not statistically significant. Among men with 10-year predicted risk Ն20%, failure to reach THR and ST-segment depression both more than doubled the risk of an event (HR, 2.66 and HR, 2.11, respectively), and each MET increment in exercise capacity reduced risk by 13% (HR, 0.87). Conclusions-Among asymptomatic men, ST-segment depression, failure to reach THR, and exercise capacity during ETT provided additional prognostic information in age-and Framingham risk score-adjusted models, particularly among those in the highest risk group (10-year predicted CHD risk of Ն20%). The evaluation of exercise test variables in women is limited, given our sample size and the few CHD events in women.

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Section: Discussionmentioning

confidence: 99%

Usefulness of Exercise Testing in the Prediction of Coronary Disease Risk Among Asymptomatic Persons as a Function of the Framingham Risk Score

et al. 2004

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“…Persons having 3 E-ECG abnormalities had a risk that was equivalent to the risk in individuals with CVD who had normal E-ECG results. 23 In another study, a 3-fold higher risk of CHD among patients with 1 or more risk factors and 2 or more abnormal features on exercise testing was found by Bruce et al 21 Similar to the findings from Bruce et al, Rywik et al 22 reported that abnormal E-ECG responses (≥1-mm horizontal or down-sloping STsegment depression) were associated with a doubling of risk of CHD events. Few studies have reported on the efficacy of E-ECG stress testing for its ability to predict CHD in persons with MetS or the components of MetS.…”

Section: Discussionmentioning

confidence: 59%

“…Our results concerning the positive association between abnormal E-ECG results and a higher risk of CHD mortality are in unison with other population-based studies of asymptomatic men with other CVD risk factors. 9,[20][21][22] The Framingham Heart Study-Offspring found that ST-segment depression provided additional prognostic information in age-and Framingham risk score-adjusted models in men, particularly among those in the highest-risk group (10-year predicted CHD risk of ≥20%). 20 This study evaluated 3043 asymptomatic men and women, who underwent a symptom-limited E-ECG test and were followed up for 18.2 years.…”

Section: Discussionmentioning

confidence: 99%

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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“…Although exercise testing is proven to have prognostic value, studies examining the relationship between exercise, electrocardiography responses and coronary heart disease mortality risk in asymptomatic men with existing cardio vascular disease risk factors are inconsistent. Most of the studies have shown a positive association in high-risk subgroups (Laukknen et al, 2001;Balady et al, 2004;Bruce et al, 1980;Rywik et al, 2002). Exercise may be a therapeutic tool in a variety of patients with, or at risk for diabetes, but that like any therapy its effects must be thoroughly understood (Schnieder et al,1990;Wasserman et al, 1994;Devlin et al, 1995).…”

Section: Journal Of Biology and Life Sciencementioning

confidence: 99%

The Hepatoprotective Effect of Olive Leaf Extract on Diabetic Pregnant Mice and Their Fetuses

Ahmad

Dawran

Uddin

et al. 2017

JBLS

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This study aimed to see the role of diet and exercise in the control of disease or in minimizing the complications associated with diabetes. This was hospital based study conducted on four hundred and twenty (420) human subjects, divided in to six (06) main groups of seventy (70) subjects each. Exercise and diet protocol was set according to the international standards. Blood and urinary glucose level of subjects from each group was estimated before the start and at different intervals during the study to compare the effect of diet and exercise in minimizing the disease associated complications. Blood and urinary glucose level of various groups of diet (252.66 ± 6.5/203.00 ± 5.1, 252.66 ± 6.5/159.90 ± 3.3 and 252.66 ± 6.5/158.24 ± 2.70) and diet as well as exercise (252.66 ± 6.5/201.90 ±4.7, 252.66 ± 6.5/164.30 ± 3.7 and 252.66 ± 6.5/157.80 ± 2.70) were compared with that of the control group. The data was recorded and analyzed on SPSS version 16. The role of diet and exercise was observed significant (P ≤ 0.05) in the control of diabetes mellitus type II. Comparison of the blood and urinary glucose levels of individual of various groups under study was made. Significance improvement on the health of individuals in the diet and exercise was observed with P-values of exercise, diet and diet + exercise groups less than 0.05 each. It is concluded that a low calorie intake with regular exercise not only reduces the economic burden of the diabetics but also minimize the associated long term fatal pathologies. The disease is a growing health concern which needs lifelong treatment. Life style modification with changes in dietary habits and exercise therapy would reduce the economic burden on poor and needy diabetics, both in term of chemotherapeutic cost in the early stage of the disease, as well as minimizing the devastating complications of the disease. Type II diabetes and its prevention and treatment is a challenge for the future. The use of drugs therapy should be restricted only where dietary restrictions and exercise fail to achieve the desired goal. Even, in patients where drug therapy is the ultimate choice, life style modifications and dietary control are extremely fruitful and minimize the associated complications.

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Role of nondiagnostic exercise-induced ST-segment abnormalities in predicting future coronary events in asymptomatic volunteers

Cited by 10 publications

References 0 publications

Usefulness of Exercise Testing in the Prediction of Coronary Disease Risk Among Asymptomatic Persons as a Function of the Framingham Risk Score

Usefulness of Exercise Testing in the Prediction of Coronary Disease Risk Among Asymptomatic Persons as a Function of the Framingham Risk Score

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

The Hepatoprotective Effect of Olive Leaf Extract on Diabetic Pregnant Mice and Their Fetuses

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