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European Heart Journal Advance Access published online on March 14, 2006
European Heart Journal, doi:10.1093/eurheartj/ehi832
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received September 26, 2005
Revised February 9, 2006
Accepted February 23, 2006

Clinical research

Chronotropic response to exercise testing is associated with carotid atherosclerosis in healthy middle-aged men

Sae Young Jae 1, Bo Fernhall 1 *, Kevin S. Heffernan 1, Mira Kang 2, Moon-Kyu Lee 2, Yoon-Ho Choi 2, and Won Hah Park 3

1 Exercise and Cardiovascular Research Laboratory, Department of Kinesiology and Community Health, College of Applied Life Studies, University of Illinois, Urbana-Champaign, 112 Huff Hall, MC-586, 1206 S. Fourth St Champaign, IL 61820
2 Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea
3 Center for Health Promotion and Sports Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

* To whom correspondence should be addressed.
Bo Fernhall, E-mail: fernhall{at}uiuc.edu


  Abstract

Aims Chronotropic incompetence, an attenuated heart rate (HR) response to exercise, is an independent predictor of cardiovascular mortality, but it is not known whether chronotropic incompetence is related to carotid atherosclerosis. The association between chronotropic incompetence and carotid atherosclerosis in 8567 (age 47.6 ± 8.8 years) healthy men was examined.

Methods and results Chronotropic incompetence was defined as the failure to achieve 85% of the age-predicted maximal HR (APMHR), <80% HR reserve (HRR), and chronotropic response index (CRI). Carotid atherosclerosis was defined, using B-mode ultrasonography, as stenosis >25% and/or intima-media thickness (IMT) of >1.2 mm. In multivariable adjusted logistic regression models, the subjects who achieved less than 85% of APMHR exhibited an odds ratio (OR) of 1.72 [95% confidence intervals (CI): 1.32-2.22] for carotid atherosclerosis. Subjects with <80% of HRR were 1.45 (95% CI: 1.14-1.84) times more likely to have carotid atherosclerosis after multivariate adjustment. Also, the OR of carotid atherosclerosis across quartiles of CRI (highest to lowest) was 1.51 (95% CI: 1.10-2.09) after multivariate adjustment.

Conclusion These results suggest that the chronotropic response to exercise is associated with carotid atherosclerosis, independent of the established risk factors in healthy men, which could contribute to high incidence of cardiovascular diseases in subjects with chronotropic incompetence.

Keywords: Chronotropic incompetence; Carotid; Atherosclerosis; Exercise testing; Heart rate.
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