Exercise capacity and heart rate recovery as predictors of coronary heart disease events, in patients with heterozygous Familial Hypercholesterolemia.
BACKGROUND
Several clinical and observational studies have established that exercise capacity and activity status are strong predictors of cardiovascular and overall mortality. We aimed to evaluate the relationship between exercise tolerance test (ETT) indices and occurrence of coronary heart disease (CHD), in patients with heterozygous Familial Hypercholesterolemia (eFH).


METHODS
During 1987-1997, we enrolled 639 cardiovascular disease-free patients with heterozygous eFH; 58 (9%) patients were excluded since they had a positive ETT. A fatal or non-fatal CHD event was the end point. Cox proportional hazards models were applied to evaluate the association between the investigated outcome and ETT indices.


RESULTS
During the follow-up (1987-2002), 53 (18%) men and 34 (10%) women developed a CHD event (11 were fatal). The age-adjusted event rate was 87 events per 2915 person-years (3%). Statistical analysis revealed that exercise capacity (hazard ratio = 0.82, P < 0.001), heart rate recovery at 1 min (hazard ratio = 0.91, P < 0.05), and peak pulse pressure levels (hazard ratio = 1.03, P < 0.001), were predictors of CHD, after controlling for several potential confounders.


CONCLUSIONS
Decreased exercise capacity, a delayed decrease in heart rate during the first minute of graded exercise, and increased peak pulse pressure are strong predictors of coronary events in patients with eFH. Physical activity should be strongly recommended in these patients.
Pitsavos
Christos H
CH
First Cardiology Department, School of Medicine, University of Athens, Greece.
Chrysohoou
Christina
C
Panagiotakos
Demosthenes B
DB
Kokkinos
Peter
P
Skoumas
John
J
Papaioannou
Ioanna
I
Michaelides
Andreas P
AP
Singh
Steven
S
Stefanadis
Christodoulos I
CI
D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000175:diagnosis* / Q000453:epidemiology; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D015996:Survival Rate