HEBERDEN,WILLIAM REVISITED - POSTPRANDIAL ANGINA INTERVAL BETWEEN FOOD AND EXERCISE AND MEAL COMPOSITION ARE IMPORTANT DETERMINANTS OF TIMETO ONSET OF ISCHEMIA AND MAXIMAL EXERCISE TOLERANCE

Objectives. This study aimed to explore the hemodynamic responses to i ngestion of meals of different composition in patients with chronic st able angina and to assess the effect of these meals on time to onset o f > 1-mm ST segment depression and limiting angina pectoris during exe rcise, Background. To our knowledge, no study has assessed the effect of meal composition and timing of exercise in patients viith coronary artery disease, Methods. Fifteen patients with chronic stable angina v isited our laboratory in the fasted state on three occasions, Measurem ents of cardiac output, heart rate and blood pressure were taken,while patients were standing, A modified Bruce exercise test was then carri ed out, during which time to onset of > 1-mm ST segment depression and limiting chest pain were recorded, Patients then ate a 2,5-MJ high fa t or high carbohydrate meal; on the third occasion, no meal was taken, At 30 min and 1 h after eating the meals, rest hemodynamic measuremen ts and exercise tests were repeated, Results. The high fat meal did no t affect exercise variables, whereas the high carbohydrate meal result ed in a reduction in time to onset of ST segment depression of 74.4 +/ - 22.2 s (mean +/- SEM) during exercise at 30 min (p < 0.01), and at b oth 30 and 60 min after the high carbohydrate meal, limiting chest pai n occurred 50 to 90 s earlier than when patients fasted (p < 0.01). Co nclusions. One hour after a high carbohydrate meal, the onset of angin a during exercise occurs earlier than in the fasted state, Despite sim ilar hemodynamic adjustments, a high fat meal does not affect exercise time. (C) 1997 by the American College of Cardiology