Maximal exercise electrocardiographic responses and coronary heart disease mortality among men with metabolic syndrome.
OBJECTIVE
To examine the association between abnormal exercise electrocardiographic (E-ECG) test results and mortality (all-cause and that resulting from coronary heart disease [CHD] or cardiovascular disease [CVD]) in a large population of asymptomatic men with metabolic syndrome (MetS).


METHODS
A total of 9191 men (mean age, 46.9 years) met the criteria of having MetS. All completed a maximal E-ECG treadmill test (May 14, 1979, through April 9, 2001) and were without a previous CVD event or diabetes at baseline. Main outcomes were all-cause mortality, mortality due to CHD, and mortality due to CVD. Cox regression analysis was used to quantify the mortality risk according to E-ECG responses.


RESULTS
During a follow-up of 14 years, 633 deaths (242 CVD and 150 CHD) were identified. Mortality rates and hazard ratios (HRs) across E-ECG responses were the following: for all-cause mortality: HR, 1.36; 95% confidence interval (CI), 1.09-1.70 for equivocal responses and HR, 1.41; 95% CI, 1.12-1.77 for abnormal responses (P(trend)<.001); for mortality due to CVD: HR, 1.29; 95% CI, 0.88-1.88 for equivocal responses and HR, 2.04; 95% CI, 1.46-2.84 for abnormal responses (P(trend)<.001); and for mortality due to CHD: HR, 1.62; 95% CI, 1.02-2.56 for equivocal responses and HR, 2.45; 95% CI, 1.62-3.69 for abnormal responses (P(trend)<.001). A positive gradient for CHD, CVD, and all-cause mortality rates across E-ECG categories within 3, 4, or 5 MetS components was observed (P<.001 for all).


CONCLUSIONS
Among men with MetS, an abnormal E-ECG response was associated with higher risk of all-cause, CVD, and CHD mortality. These findings underscore the importance of E-ECG tests to identify men with MetS who are at risk of dying.
Department of Kinesiology, School of Health, Kinesiology, and Sport Studies, Coastal Carolina University, PO Box 261954, Conway, SC 29528, USA. glyerly@coastal.edu
G William
GW
Lyerly
Xuemei
X
Sui
Timothy S
TS
Church
Carl J
CJ
Lavie
Gregory A
GA
Hand
Steven N
SN
Blair
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D004562:Electrocardiography; D005080:Exercise Test / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult