MAXIMAL EXERCISE HEMODYNAMICS AND RISK OF MORTALITY IN APPARENTLY HEALTHY-MEN AND WOMEN

The purpose of this investigation was to determine the association of maximal exercise hemodynamic responses with risk of mortality due to a ll-causes, cardiovascular disease (CVD), and coronary heart disease (C HD) in a population of apparently healthy individuals. Study participa nts were 20,387 men (mean age = 42.2 yr) and 6,234 women (mean age = 4 1.9 yr), patients of a preventive medicine center in Dallas, TX, exami ned between 1971 and 1989. Maximal heart rate and maximal systolic blo od pressure (SEP) measured during the maximal exercise test were relat ed to risk of all-cause, CVD, and CHD mortality. During an average of 8.1 yr of follow-up, there were 348 deaths in men and 66 deaths in wom en. Among men, after adjustment for confounding variables, risks (and 95% confidence interval (CI)) of all-cause mortality for quartiles of maximal SEP, relative to the lowest quartile, were: 0.96 (0;70-1.33), 1.36 (1.01-1.85), and 1.37 (0.98-1.92) for quartiles 2-4, respectively . Similarly adjusted risks for maximal heart rate were: 0.61 (0.44-0.8 5), 0.69 (0.51-0.93), and 0.60 (0.41-0.87). Similar results were seen for risk of CVD and CHD death. In women, similar trends in adjusted ri sks of all-cause and CVD mortality across maximal SEP and heart rate c ategories were observed. For maximal heart rate, a 35 bpm higher value was associated with a 36% decreased risk of CVD mortality in men (RR = 0.63,95% CI = 0.34-0.71) and an 8% lower risk in women (RR = 0.92,95 % CI = 0.18-4.63). These results suggest that an exaggerated SEP or an attenuated heart rate response to maximal exercise may indicate an el evated risk for mortality in this apparently healthy population.