Circulation, Vol 74, 252-261, Copyright © 1986 by American Heart Association
DJ Gordon, LG Ekelund, JM Karon, JL Probstfield, C Rubenstein, LT Sheffield and L Weissfeld
More than 3600 white men, from 30 to 79 years old and without a history of
myocardial infarction, underwent submaximal treadmill exercise tolerance
tests as part of their baseline evaluation for the Lipid Research Clinics
Mortality Follow-up Study. The exercise test was conducted according to a
common protocol and coded centrally; depression of the ST segment by at
least 1 mm (visual coding) and/or 10 microV-sec (ST integral, computer
coding) signified a positive test. Concurrent measurements of age, blood
pressure, history of cigarette smoking, and plasma levels of lipids,
lipoproteins, and glucose, as well as other coronary risk factors, were
obtained. Cumulative mortality from cardiovascular disease was 11.9%
(22/185) over 8.1 years mean follow-up among men with a positive exercise
test vs 1.2% (36/2993) over 8.6 years mean follow-up among men with a
negative test. Three-quarters (43) of these deaths were due to coronary
heart disease. The relative risk for cardiovascular mortality associated
with a positive exercise test was 9.3 before and 4.6 after age adjustment.
Cardiovascular mortality rates were especially elevated (relative risk 15.6
before and 5.1 after age adjustment) among the 82 men whose exercise tests
were adjusted "strongly" positive based on degree and timing of the
ischemic electrocardiographic response. A positive exercise test was also
moderately associated with noncardiovascular mortality; the relative risk
for all-cause mortality was 7.2 before and 3.4 after age adjustment. The
relative risk for cardiovascular mortality associated with a positive
exercise test was not appreciably altered by covariance adjustment for
known coronary risk factors other than age. A positive exercise test was a
stronger predictor of cardiovascular death than were high plasma levels of
low-density lipoprotein cholesterol, low plasma levels of high-density
lipoprotein cholesterol, smoking, hyperglycemia, or hypertension. Its
impact on risk of cardiovascular death was equivalent to that of a 17.4
year increment in age.
ARTICLES
Predictive value of the exercise tolerance test for mortality in North American men: the Lipid Research Clinics Mortality Follow-up Study
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