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Carotid stenosis is a powerful predictor of a positive exercise electrocardiogram in a large hyperlipidemic
E Bruckert1, P Giral, J Salloum
1Service d'Endocrinologie-Métabolisme, Hôpital Pitié Salpétriére, Paris, France.
Insights
For patients with hyperlipidemia, screening with exercise electrocardiogram (ECG) is most beneficial for those with carotid atherosclerosis. This identifies individuals at higher risk for coronary heart disease (CHD) and stroke.
Area of Science:
- Cardiology
- Vascular Medicine
- Preventive Cardiology
Background:
- Hypercholesterolemia is a significant risk factor for coronary heart disease (CHD) and ischemic stroke.
- The utility of routine stress exercise electrocardiogram (ECG) screening for hyperlipidemia patients remains debated.
- Effective screening requires identifying individuals with a high prevalence of CHD.
Purpose of the Study:
- To assess if carotid artery atherosclerosis predicts a positive exercise ECG in asymptomatic hyperlipidemic patients.
- To determine the value of carotid ultrasound in guiding exercise ECG screening decisions.
Main Methods:
- A study involving 778 asymptomatic patients with hyperlipidemia.
- Ultrasonographic examination to detect carotid artery atherosclerosis.
- Multiple regression analysis of 13 parameters, including demographics, lipids, and atherosclerosis severity.
Main Results:
- Patients with carotid atherosclerosis showed a significantly higher percentage of positive exercise ECG results.
- Age and the degree of carotid atherosclerosis were the strongest predictors of a positive exercise ECG test.
- The severity of carotid lesions independently predicted exercise ECG positivity.
Conclusions:
- Hyperlipidemic patients with evidence of carotid atherosclerosis are the ideal candidates for exercise ECG screening.
- Carotid artery assessment can help stratify risk and optimize the use of exercise ECG for CHD detection.
- This approach enhances the clinical utility of exercise ECG in managing hyperlipidemia and preventing cardiovascular events.
Abstract:
Hypercholesterolemia is a major risk factor in coronary heart disease (CHD) and ischemic stroke. However, there is no general agreement on the usefulness of systematic screening of patients with hyperlipidemia by stress exercise electrocardiogram (ECG). The feasibility of this approach would depend on selecting patients with a high risk of CHD, since the sensitivity and specificity of the test depends on the prevalence of the disease. In view of the association of CHD and ischemic stroke, we undertook a study to determine whether the presence of atherosclerosis in the carotid arteries was predictive of a positive exercise ECG in a group of 778 asymptomatic patients referred to their hyperlipidemia. We a much higher percentage of positive exercise ECG in patients with carotid atherosclerosis in our ultrasonographic examinations. In a multiple regression analysis which included 13 parameters (age, sex, body mass index, arterial blood pressure, lipid parameters, serum level of glucose, smoking status and the severity of carotid lesions), the strongest predictors of a positive exercise ECG test were age (P = 0.014) and the degree of carotid atherosclerosis (P = 0.010). We therefore conclude that hyperlipidemic patients with atherosclerotic lesions on carotid arteries would benefit most from screening by the exercise ECG.