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(Circulation. 2008;117:2734-2742.)
© 2008 American Heart Association, Inc.

Coronary Heart Disease

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

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

From the Department of Exercise Science (G.W.L., X.S., G.A.H., S.N.B.), Arnold School of Public Health, University of South Carolina, Columbia, SC; Pennington Biomedical Research Center (T.S.C.), Baton Rouge, La; Department of Cardiovascular Diseases (C.J.L.), Ochsner Medical Center, New Orleans, La; Department of Epidemiology and Biostatistics (S.N.B.), Arnold School of Public Health, University of South Carolina, Columbia, SC; and Department of Kinesiology, Health Promotion, and Recreation (S.N.B.), University of North Texas, Denton, Tex.

Correspondence to G. William Lyerly, MS, 921 Assembly St, Columbia, SC 29208. E-mail gwlyerl{at}gwm.sc.edu

Received July 20, 2007; accepted March 25, 2008.

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. However, little is known about the relationship between exercise ECG responses and CHD risk in men with diabetes mellitus.

Methods and Results— We examined the association between exercise ECG responses and mortality in 2854 men with documented diabetes mellitus (mean age 49.5 years) who completed a maximal treadmill exercise test during the period from 1974 to 2001 and who were without a previous cardiovascular disease (CVD) event at baseline. Mortality due to all causes, CHD, and CVD were the main outcome measures across categories of exercise ECG responses, with stratification by cardiorespiratory fitness, quantified as treadmill test duration. During an average follow-up of 16 years, 441 deaths (210 CVD and 133 CHD) were identified. Across normal, equivocal, and abnormal exercise ECG groups, age- and examination year–adjusted CHD mortality rates per 10 000 person-years were 23.0, 48.6, and 69.0, respectively (P_trend<0.001). After further adjustment for fasting plasma glucose level, smoking, body mass index, hypercholesterolemia, hypertension, family history of CVD or diabetes mellitus, abnormal resting ECG responses, and cardiorespiratory fitness, hazard ratios (95% confidence intervals) were 1.00 (referent), 1.68 (1.01 to 2.77), and 2.21 (1.41 to 3.46; P_trend<0.001). Similar patterns of associations were noted between exercise ECG testing and both CVD and all-cause mortality risk.

Conclusions— Among men with diabetes mellitus, equivocal and abnormal exercise ECG responses were associated with higher risk of all-cause, CVD, and CHD mortality.

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