title: Cardiac power during exercise and the risk of stroke in men.
abstract: OBJECTIVE
  Low maximal oxygen uptake (VO2max) has been shown to predict the risk of stroke. However, VO2max does not take into account the differences in cardiac afterload between subjects. The aim of this study was to examine the relationship of exercise cardiac power (ECP), defined as a ratio of VO2max with peak systolic blood pressure (SBP) during exercise, with the risk for stroke.
  
  
  METHODS
  Population-based cohort study with an average follow-up of 12 years from eastern Finland. A total of 1761 men with no history of stroke or coronary heart disease at baseline participated. Among these men, 91 strokes occurred, of which 69 were attributable to ischemic causes.
  
  
  RESULTS
  The relative risk of any stroke in men with low ECP (<10.3 mL/mm Hg) was 2.7 (95% CI, 1.2 to 6.0; P=0.01; P=0.02 for the trend across the quartiles), and the relative risk for ischemic stroke was 2.7 (95% CI, 1.1 to 7.0; P=0.03; P=0.04 for trend across the quartiles) compared with men having high ECP (>14.3 mL/mm Hg) during exercise after adjusting for age, examination year, cigarette smoking, alcohol consumption, body mass index, diabetes, serum total cholesterol level, energy expenditure of physical activity, exercise-induced myocardial ischemia, and the use of antihypertensive medication. After further adjustment for resting SBP, results were statistically nonsignificant.
  
  
  CONCLUSIONS
  Low ECP provides noninvasive and easily available measure for stroke risk. One of the most potential explanations for the association between ECP and the increased risk of stroke is an elevated afterload and peripheral resistance indicated by elevated SBP.
authors.affiliation: Research Institute of Public Health, University of Kuopio, Kuopio, Finland. sudhir.kurl@uku.fi
authors.forename: S
authors.initials: S
authors.lastname: Kurl
authors.forename: J A
authors.initials: JA
authors.lastname: Laukkanen
authors.forename: L
authors.initials: L
authors.lastname: Niskanen
authors.forename: R
authors.initials: R
authors.lastname: Rauramaa
authors.forename: T P
authors.initials: TP
authors.lastname: Tuomainen
authors.forename: J
authors.initials: J
authors.lastname: Sivenius
authors.forename: J T
authors.initials: JT
authors.lastname: Salonen
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002545:Brain Ischemia; D015331:Cohort Studies; D015444:Exercise; D005080:Exercise Test; D017079:Exercise Tolerance; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D010809:Physical Fitness; D011446:Prospective Studies; D012306:Risk; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology
chemical_list: D010100:Oxygen