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Maximal exercise electrocardiography responses and coronary heart disease mortality among men with diabetes mellitus.
Circulation 2008; 117(21):2734-42Circ

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. 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.

Authors+Show Affiliations

Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA. gwlyerl@gwm.sc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

18490521

Citation

Lyerly, G William, et al. "Maximal Exercise Electrocardiography Responses and Coronary Heart Disease Mortality Among Men With Diabetes Mellitus." Circulation, vol. 117, no. 21, 2008, pp. 2734-42.
Lyerly GW, Sui X, Church TS, et al. Maximal exercise electrocardiography responses and coronary heart disease mortality among men with diabetes mellitus. Circulation. 2008;117(21):2734-42.
Lyerly, G. W., Sui, X., Church, T. S., Lavie, C. J., Hand, G. A., & Blair, S. N. (2008). Maximal exercise electrocardiography responses and coronary heart disease mortality among men with diabetes mellitus. Circulation, 117(21), pp. 2734-42. doi:10.1161/CIRCULATIONAHA.107.729277.
Lyerly GW, et al. Maximal Exercise Electrocardiography Responses and Coronary Heart Disease Mortality Among Men With Diabetes Mellitus. Circulation. 2008 May 27;117(21):2734-42. PubMed PMID: 18490521.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maximal exercise electrocardiography responses and coronary heart disease mortality among men with diabetes mellitus. AU - Lyerly,G William, AU - Sui,Xuemei, AU - Church,Timothy S, AU - Lavie,Carl J, AU - Hand,Gregory A, AU - Blair,Steven N, Y1 - 2008/05/19/ PY - 2008/5/21/pubmed PY - 2008/7/1/medline PY - 2008/5/21/entrez SP - 2734 EP - 42 JF - Circulation JO - Circulation VL - 117 IS - 21 N2 - 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. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/18490521/Maximal_exercise_electrocardiography_responses_and_coronary_heart_disease_mortality_among_men_with_diabetes_mellitus_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.107.729277?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -