title: Exercise-induced silent myocardial ischemia and coronary morbidity and mortality in middle-aged men.
abstract: OBJECTIVE
  We investigated the prognostic significance of exercise-induced silent myocardial ischemia in both high and low risk men with no prior coronary heart disease (CHD).
  
  
  BACKGROUND
  Silent ischemia predicts future coronary events in patients with CHD, but there is little evidence of its prognostic significance in subjects free of CHD.
  
  
  METHODS
  We investigated the association of silent ischemia, as defined by ST depression during and after maximal symptom-limited exercise test, with coronary risk in a population-based sample of men with no prior CHD followed for 10 years on average.
  
  
  RESULTS
  Silent ischemia during exercise was associated with a 5.9-fold (95% CI 2.3 to 11.8) CHD mortality in smokers, 3.8-fold (95% CI 1.9 to 7.9) in hypercholesterolemic men and 4.7-fold (95% CI 2.4 to 9.1) in hypertensive men adjusting for other risk factors. The respective relative risks (RRs) of any acute coronary event were 3.0 (95% CI 1.7 to 5.1), 1.9 (95% CI 1.2 to 3.1) and 2.2 (95% CI 1.4 to 3.5). These associations were weaker in men without these risk factors. Furthermore, silent ischemia after exercise was a stronger predictor for the risk of acute coronary events and CHD death in smokers and in hypercholesterolemic and hypertensive men than in men without risk factors.
  
  
  CONCLUSIONS
  Exercise-induced silent myocardial ischemia was a strong predictor of CHD in men with any conventional risk factor, emphasizing the importance of exercise testing to identify asymptomatic high risk men who could benefit from risk reduction and preventive measures.
authors.affiliation: Research Institute of Public Health, University of Kuopio, Finland.
authors.forename: J A
authors.initials: JA
authors.lastname: Laukkanen
authors.forename: S
authors.initials: S
authors.lastname: Kurl
authors.forename: T A
authors.initials: TA
authors.lastname: Lakka
authors.forename: T P
authors.initials: TP
authors.lastname: Tuomainen
authors.forename: R
authors.initials: R
authors.lastname: Rauramaa
authors.forename: R
authors.initials: R
authors.lastname: Salonen
authors.forename: J
authors.initials: J
authors.lastname: Eränen
authors.forename: J T
authors.initials: JT
authors.lastname: Salonen
mesh_terms: D003327:Coronary Disease / Q000453:epidemiology*; D004562:Electrocardiography; D015444:Exercise; D005080:Exercise Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors