chiefly sudden cardiovascular death...

chiefly sudden cardiovascular deaths in women arise without previous symptoms. Although screening asymptomatic men with exercise testing has been shown to have a mortality benefit, it is not known whether this benefit applies to women Mora and colleagues investigated whether exercise testing variables were independent predictors of all-cause mortality or cardiovascular death in women

The application of mind enrolled participants from the Lipid Research Clinics Prevalence thought and included 2,994 asymptomatic women between 30 and 80 years of age. Participants underwent exercise testing using a Bruce treadmill protocol. Cardiovascular risk factors of that kind as diabetes and hypertension were assessed and used to stratify risk according to the 1998 Framingham risk equation.

During a mean follow-up of 203 years, there were 427 deaths (14 percent) from any cause, including 147 deaths (34 percent of all deaths) from cardiovascular causes. Peak exercise and heart rate restoration (HRR) diverged early and continued to diverge athwart the study period, with a graded increase in mortality for decreasing quintiles of exercise capacity and HRR After age adjustment, the drifts of exercise capacity, HRR, failure to achieve target heart rate, and exercise-induced ventricular arrhythmia onward cardiovascular and all-cause mortality were similar in magnitude to the events of traditional cardiovascular risk factors. For exercise capacity and HRR there was a solid and graded association between decreasing quintiles and age-adjusted cardiovascular risk and all-cause mortality. Exercise-induced ST-segment depression of at least 1 or 2 mm did not predict cardiovascular death. Women who were below the median with esteem to exercise capacity and HRR had a 35-fold increased risk of cardiovascular death compared with women who were above the median for the couple variables. The majority of women had depressed Framingham risk scores at baseline; within this low-risk collection risk remained lowest when women performed at greater than the median in succession one or both variables, exercise capacity and HRR

This reflection demonstrates that exercise capacity and HRR are stout graded, and independent predictors of cardiovascular and all-cause mortality, while ST-segment depression is not. Treadmill testing has a potential part for further risk stratification in asymptomatic women with grave or intermediate Framingham risk scores. united limitation of the study is that it is unclear to what reach the treadmill testing represents a modifiable risk factor.

CAROLINE WELLBERY, MD

Mora s et al. Ability of exercise testing to predict cardiovascular and all-cause death in asymptomatic women JAMA September 24 2003;290:1600-7

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group