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(Circulation. 1999;100:e119.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Exercise-Induced Ischemia and Carotid Atherosclerosis

Peter M. Okin, MD; Mary J. Roman, MD; Richard B. Devereux, MD

Division of Cardiology, Department of Medicine, Weill Medical College of Cornell University, New York, NY

	Introduction

 
To the Editor:

We read with interest the recent article by Nagai et al¹ detailing the significant association between exercise-induced myocardial ischemia and carotid artery intimal-medial thickness in asymptomatic participants in the Baltimore Longitudinal Study of Aging. These findings highlight and support previously reported observations from our laboratory on the relation between exercise ECG manifestations of ischemia and carotid artery structure and plaque.²

The relationship of exercise ECG myocardial ischemia to the presence of carotid atherosclerosis and to carotid and left ventricular structure and function was examined in a population of 204 asymptomatic subjects free of clinical evidence of cardiovascular disease. We found that exercise-induced myocardial ischemia, as defined by an abnormal chronotropically adjusted ST/heart rate (HR) slope³ but not by standard ST depression criteria, was associated with a nearly 3-fold greater likelihood of discrete carotid plaque and with older age, male sex, higher systolic and diastolic blood pressures, greater left ventricular mass and mass index, and greater common carotid artery intimal-medial thickness and cross-sectional area index. Stepwise logistic regression analyses that included standard cardiac risk factors revealed that only carotid cross-sectional area index, systolic blood pressure, and/or left ventricular mass index predicted the presence of exercise-induced myocardial ischemia.

Although the subjects in our study were on average 15 to 20 years younger than the subjects examined by Nagai et al,¹ the findings from the 2 studies are remarkably similar with respect to the associations between ECG evidence of ischemia and carotid atherosclerosis, thus extending these observations to nearly the . . . [Full Text of this Article]