European Heart Journal Advance Access originally published online on January 6, 2006
European Heart Journal 2006 27(5):582-588; doi:10.1093/eurheartj/ehi708
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Heart rate response during exercise test and cardiovascular mortality in middle-aged men
1Kuopio Research Institute of Exercise Medicine, Haapaniementie 16, 70100 Kuopio, Finland
2Department of Physiology, University of Kuopio, Kuopio, Finland
3Pennington Biomedical Research Center, Baton Rouge, LA, USA
4Research Institute of Public Health, University of Kuopio, Kuopio, Finland
5IT Service Centre, University of Kuopio, Kuopio, Finland
6Department of Community Health and General Practise, University of Kuopio, Kuopio, Finland
7Inner Savo Health Centre, Suonenjoki, Finland
8Oy Jurilab Ltd, Kuopio, Finland
9Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
Received 2 April 2005; revised 15 November 2005; accepted 8 December 2005; online publish-ahead-of-print 6 January 2006.
* Corresponding author. Tel: +358 17 2884444; fax: +358 17 2884488. E-mail address: rainer.rauramaa{at}messi.uku.fi
Aims The objective is to study whether a heart rate (HR) response during exercise test independently predicts cardiovascular disease (CVD) mortality.
Methods and results The subjects were a representative sample of 1378 men, 42–61 years of age, from eastern Finland with neither prior coronary heart disease (CHD) nor use of ß-blockers at baseline. HR was measured at rest and during a maximal, symptom-limited exercise test at 20, 40, 60, 80, and 100% of maximal workload. During an average follow-up of 11.4 years, there were 56 deaths due to CVD.
The slope of HR increase during exercise test was steeper in survivors when compared with those who died due to CVD during follow-up (P<0.001), and the difference in the steepness of HR slope between the groups was the strongest at interval 40–100% (P<0.001). In Cox-multivariable models, maximal HR–HR at 40% workload as a continuous variable was inversely associated with CVD (P=0.04), CHD (P=0.004), and all-cause (P=0.002) mortality after adjustment for known risk factors for CVD death.
Conclusion By considering an HR response throughout an exercise test, we found that a blunted HR increase at 40–100% of maximal workload was associated with increased CVD mortality.
Key Words: Exercise testing • Heart rate • Cardiovascular diseases
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