EXERCISE-INDUCED SILENT-MYOCARDIAL-ISCHEMIA IN MASTER ATHLETES

High-physical activity levels are associated with reduced risk of symp tomatic coronary artery disease (CAD). However, there are a number of reports of exercise-related sudden death and myocardial infarction in aerobically trained athletes, This study compared the prevalence of ex ercise-induced silent myocardial ischemia on maximum graded exercise t ests with tomographic thallium scintigraphy in 70 master male athletes (63 +/- 6 years, mean +/- SD) (maximum aerobic capacity, (V) over dot O(2)max >40 ml/kg/min) and in 85 healthy untrained men (61 +/- 7 year s) with no history of CAD, The prevalence of silent ischemia (exercise -induced ST-segment depression on electrocardiogram and perfusion abno rmalities on thallium scintigraphy) was similar in athletes and untrai ned men; 16% of the athletes (11 of 70) had silent ischemia compared w ith 21% of the untrained men (chi-square = 0.81, p = 0.36), No athlete s had hyperlipidemia, systemic hypertension, or diabetes mellitus, How ever, the apolipoprotein E4 allele was present in 9 of the 11 athletes with silent ischemia compared with 2 of 32 athletes with normal exerc ise tests (chi-square = 24, p = 0.0001), These results suggest that ol der male athletes with the apolipoprotein E4 allele are at increased r isk for the development of exercise-induced silent ischemia. (C) 1998 by Excerpta Medica, Inc.