title: The treadmill exercise-tolerance test is useful for the prediction and prevention of ischemic coronary events in elderly diabetics.
abstract: BACKGROUND
  Approximately 80% of cases of ischemic heart disease (IHD) occur in patients with nonstenotic coronary arteries, and few studies have systematically assessed exercise testing (TMT) as a predictor of risk in the elderly.
  
  
  METHODS
  TMT was carried out using a protocol for the independent and active elderly (n=176). After 4.1+/-0.5 years follow-up, logistic regression analysis was performed for each coronary risk factor such as diabetes mellitus (DM) and hypercholesterolemia (HC). According to the results, patients were divided into Gp HC, hypercholesterolemic patients; Gp DM, diabetics; Gp HC+DM, hypercholesterolemic diabetics; and Gp C, nonhyperlipidemic and nondiabetics. Sensitivity and specificity of TMT for IHD (significant stenosis or acute coronary syndrome) were analyzed.
  
  
  RESULTS
  Odds ratios for each risk factors are as follows: DM, 4.167; HC, 4.485; and DM+HC, 8.652. Notably, TMT was 17.59. Age was a significant risk, but hypertension was not. Positive ischemic signs in TMT were observed in 52.7%, 28.6%, 33.3%, and 16.3% in the Gp HC+DM, HC, DM, and C groups, respectively. Only three participants complained of chest pain during the TMT. Significant stenosis was observed in 75.0%, 71.4%, 69.2%, and 60.0% of coronary angiography (CAG)-receiving patients of Gp HC, DM, HC+DM, and C. During the observation term, acute coronary syndromes occurred in 4.7%, 3.3%, 5.5%, and 0% of patients in the Gp HC, DM, HC+DM, and C groups, respectively. The sensitivity of TMT for IHD was higher than 66.7% and specificity was higher than 94.1% in each group.
  
  
  CONCLUSIONS
  An exercise tolerance test in the elderly, especially for diabetics and hypercholesterolemic patients, is useful for the diagnosis of IHD.
authors.affiliation: Department of Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan. hayashi@med.nagoya-u.ac.jp
authors.forename: Toshio
authors.initials: T
authors.lastname: Hayashi
authors.forename: Hideki
authors.initials: H
authors.lastname: Nomura
authors.forename: Teiji
authors.initials: T
authors.lastname: Esaki
authors.forename: Ayako
authors.initials: A
authors.lastname: Hattori
authors.forename: Hatsuyo
authors.initials: H
authors.lastname: Kano-Hayashi
authors.forename: Akihisa
authors.initials: A
authors.lastname: Iguchi
mesh_terms: D000367:Age Factors; D000368:Aged; D048909:Diabetes Complications / Q000517:prevention & control; D005080:Exercise Test; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D012307:Risk Factors