Abstract
Background: Several clinical and observational studies have established that exercise capacity
and activity status are strong predictors of cardiovascular and overall mortality.
We aimed to evaluate the relationship between exercise tolerance test (ETT) indices
and occurrence of coronary heart disease (CHD), in patients with heterozygous Familial
Hypercholesterolemia (eFH). Methods: During 1987–1997, we enrolled 639 cardiovascular disease-free patients with heterozygous
eFH; 58 (9%) patients were excluded since they had a positive ETT. A fatal or non-fatal
CHD event was the end point. Cox proportional hazards models were applied to evaluate
the association between the investigated outcome and ETT indices. Results: During the follow-up (1987–2002), 53 (18%) men and 34 (10%) women developed a CHD
event (11 were fatal). The age-adjusted event rate was 87 events per 2915 person-years
(3%). Statistical analysis revealed that exercise capacity (hazard ratio=0.82, P<0.001), heart rate recovery at 1 min (hazard ratio=0.91, P<0.05), and peak pulse pressure levels (hazard ratio=1.03, P<0.001), were predictors of CHD, after controlling for several potential confounders.
Conclusion: Decreased exercise capacity, a delayed decrease in heart rate during the first minute
of graded exercise, and increased peak pulse pressure are strong predictors of coronary
events in patients with eFH. Physical activity should be strongly recommended in these
patients.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to AtherosclerosisAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Mortality over two centuries in large pedigree with Familial Hypercholesterolemia: family tree mortality study.BMJ. 2001; 322: 1019-1023
- Increased prevalence of coronary Ectasia in heterozygous Familial Hypercholesterolemia.Circulation. 1995; 91: 1375-1380
- Molecular genetics of the LDL receptor gene in Familial Hypercholesterolemia.Hum. Mutat. 1992; 1: 445-466
Gordstein JL, Hobbs HH, Brown MS. Familial Hypercholesterolemia. In: Scriver CR, Beauder AL, Sly WS, Valle D, editors. Metabolic and molecular bases of inheritate disease. 7th ed. New York, McGraw-Hill; 1995. p. 1981–2030.
- Clinical and exercise test markers of prognosis in patients with stable coronary artery disease.Curr. Probl. Cardiol. 1994; 19: 533-587
- Physical activity and public health: a recommendation from the Centre for Disease Control and Prevention and the American College of Sports Medicine.JAMA. 1995; 273: 402-407
- Exercise standards: a statement for healthcare professionals from the American Heart Association.Circulation. 1995; 91: 580-615
- Exercise testing for chronotropic assessment.Cardiol. Clin. 1992; 10: 705-717
- Confidence bands for receiver operating characteristic curve.Med. Decision Making. 1993; 13: 191-197
- Results of a multicenter randomized clinical trial of exercise and long-term survival in myocardial infarction patients.Circulation. 1999; 100: 1764-1769
- Exercise capacity and mortality among men referred for exercise testing.N. Engl. J. Med. 2002; 346: 793-901
- Relation of leisure-time physical activity and cardiorespiratory fitness to the risk of acute myocardial infarction.N. Engl. J. Med. 1994; 330: 1549-1554
- Exercise intensity and longevity in men: the Harvard Alumni Health Study.JAMA. 1995; 273: 1179-1184
- Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine.JAMA. 1995; 273: 402-407
- Heart-rate recovery immediately after exercise, as a predictor of mortality.N. Engl. J. Med. 1999; 341: 1351-1357
- Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure.J. Am. Coll. Cardiol. 1994; 24: 1529-1535
- Autonomic nervous system and sudden cardiac death: experimental basis and clinical observations for post-myocardial infarction risk stratification.Circulation. 1992; 85: 1-77
- Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham heart study.Circulation. 1999; 100: 354-360
- Ambulatory pulse pressure as predictor of outcome in older patients with systolic hypertension.Am. J. Hypertens. 2002; 15: 835-843
- Large artery stiffness predicts ischemic threshold in patients with coronary heart disease.J. Am. Coll. Cardiol. 2002; 40: 770-773
- Additional risk factors influence excess mortality in heterozygous Familial Hypercholesterolemia.Atherosclerosis. 2000; 149: 421-425
Scientific Steering Committee on behalf of the Simon Broome Register Group Mortality in treated heterozygous familial hypercholesterolaemia: implications for clinical management. Atherosclerosis 1999;142:105–12.
- Importance of HDL cholesterol levels and the total/HDL cholesterol ratio as a risk factor for coronary heart disease in molecularly defined heterozygous Familial Hypercholesterolemia.Eur. Heart J. 2001; 22: 465-471
- Angiographically silent atherosclerosis detected by intravascular ultrasound in patients with Familial Hypercholesterolemia and familial combined hyperlipidemia: correlation with high density lipoproteins.J. Am. Coll. Cardiol. 1996; 27: 1562-1570
- Status and management of hypertension, in Greece the role of the adoption of Mediterranean diet: the ATTICA study.J. Hypertens. 2003; 21: 1483-1489
Article Info
Publication History
Accepted:
December 18,
2003
Received in revised form:
November 20,
2003
Received:
September 8,
2003
Identification
Copyright
© 2004 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
