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(Circulation. 1997;96:2899-2904.)
© 1997 American Heart Association, Inc.
Articles |
Heart Rate Adjustment of Exercise-Induced ST-Segment Depression Identifies Men Who Benefit From a Risk Factor Reduction Program
From the Division of Cardiology (P.M.O., P.K.), Department of Medicine, The New York Hospital–Cornell Medical Center, New York; Division of Biostatistics (G.G.), School of Public Health, University of Minnesota, Minneapolis; EPICARE Center (P.M.R.), Bowman Gray University, Winston Salem, NC; Department of Epidemiology and Public Health (R.J.P.), University of Miami School of Medicine (Florida); Saint Louis University (J.D.C.), Saint Louis, Mo; Laboratory of Physiological Hygiene (R.S.C.), School of Public Health, University of Minnesota, Minneapolis.
Correspondence to Peter M. Okin, MD, The New York Hospital–Cornell Medical Center, 525 E 68th St, New York, NY 10021. E-mail pokin{at}mail.med.cornell.edu
Background Whether subjects identified as being at increased risk of coronary heart disease (CHD) death by heart rate adjustment of exercise-induced ST-segment depression will benefit from therapy aimed at reducing risk factors has not been examined.
Methods and Results Exercise ECGs were performed in 11 880 men
from the Usual Care (UC) and Special Intervention (SI) groups of the
Multiple Risk Factor Intervention Trial. UC men were referred to
customary sources of care in the community; SI men received counseling
on smoking cessation and dietary reduction of cholesterol,
and stepped-care therapy for hypertension. An abnormal ST-segment
response to exercise was defined according to standard criteria as
100 µV of additional horizontal or downsloping ST-segment
depression and by an ST-segment/heart rate (ST/HR) index >1.60
µV/bpm. After 7 years of follow-up, CHD mortality was significantly
lower in SI than UC men with an abnormal ST/HR index (2.4%, 19/786
versus 5.3%, 39/729, P=.005) but was comparable in SI and
UC men with a normal ST/HR index (1.6%, 84/5154 versus 1.3%, 70/5211,
P=NS). Risk reduction in SI men with an abnormal ST/HR index
was independent of age and other cardiac risk factors. In contrast,
there was no significant difference in CHD death rate between the
smaller groups of SI and UC men with an abnormal test by standard
criteria (3.6%, 7/192 versus 2.7%, 5/186, P=NS).
Conclusions An abnormal ST/HR index identifies men in whom therapy aimed at reducing CHD risk factors reduces the risk of CHD death by 61%. These findings support the application of heart rate adjustment of ST depression for screening of asymptomatic subjects at increased risk of CHD to identify those who will benefit most from risk factor–reduction programs.
Key Words: coronary disease • electrocardiography • exercise • heart rate • risk factors
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