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Updated: Jun 16, 2026
Conducting Maximal and Submaximal Endurance Exercise Testing to Measure Physiological and Biological Responses to Acute Exercise in Humans
Published on: October 17, 2018
Maximal exercise electrocardiographic responses and coronary heart disease mortality among men with metabolic
G William Lyerly1, Xuemei Sui, Timothy S Church
1Department of Kinesiology, School of Health, Kinesiology, and Sport Studies, Coastal Carolina University, PO Box 261954, Conway, SC 29528, USA. glyerly@coastal.edu
Insights
Abnormal exercise electrocardiographic (E-ECG) test results in men with metabolic syndrome (MetS) are linked to increased all-cause, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality. E-ECG is crucial for risk stratification in this population.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Research
Background:
- Metabolic syndrome (MetS) is a cluster of risk factors increasing cardiovascular disease (CVD) and coronary heart disease (CHD) risk.
- Exercise electrocardiography (E-ECG) is a common diagnostic tool, but its prognostic value in asymptomatic men with MetS is less understood.
Purpose of the Study:
- To investigate the association between abnormal E-ECG test results and mortality outcomes in a large cohort of asymptomatic men diagnosed with MetS.
- To determine if E-ECG findings can predict all-cause, CVD, and CHD mortality in this specific population.
Main Methods:
- A cohort of 9191 asymptomatic men with MetS underwent maximal E-ECG treadmill testing.
- Participants were followed for a median of 14 years for all-cause, CVD, and CHD mortality.
- Cox regression analysis was employed to assess mortality risk associated with E-ECG responses.
Main Results:
- Abnormal E-ECG responses were significantly associated with increased all-cause mortality (HR 1.41) and CVD mortality (HR 2.04).
- Equivocal and abnormal E-ECG results showed a graded increase in CHD mortality risk (HRs 1.62 and 2.45, respectively).
- A significant trend of increasing mortality rates across E-ECG categories was observed with increasing numbers of MetS components.
Conclusions:
- In asymptomatic men with MetS, abnormal E-ECG results are a significant predictor of higher all-cause, CVD, and CHD mortality.
- E-ECG testing plays a vital role in identifying individuals with MetS who are at elevated risk of mortality, aiding in risk stratification and management.
Objective:
To examine the association between abnormal exercise electrocardiographic (E-ECG) test results and mortality (all-cause and that resulting from coronary heart disease [CHD] or cardiovascular disease [CVD]) in a large population of asymptomatic men with metabolic syndrome (MetS).
Patients And Methods:
A total of 9191 men (mean age, 46.9 years) met the criteria of having MetS. All completed a maximal E-ECG treadmill test (May 14, 1979, through April 9, 2001) and were without a previous CVD event or diabetes at baseline. Main outcomes were all-cause mortality, mortality due to CHD, and mortality due to CVD. Cox regression analysis was used to quantify the mortality risk according to E-ECG responses.
Results:
During a follow-up of 14 years, 633 deaths (242 CVD and 150 CHD) were identified. Mortality rates and hazard ratios (HRs) across E-ECG responses were the following: for all-cause mortality: HR, 1.36; 95% confidence interval (CI), 1.09-1.70 for equivocal responses and HR, 1.41; 95% CI, 1.12-1.77 for abnormal responses (P(trend)<.001); for mortality due to CVD: HR, 1.29; 95% CI, 0.88-1.88 for equivocal responses and HR, 2.04; 95% CI, 1.46-2.84 for abnormal responses (P(trend)<.001); and for mortality due to CHD: HR, 1.62; 95% CI, 1.02-2.56 for equivocal responses and HR, 2.45; 95% CI, 1.62-3.69 for abnormal responses (P(trend)<.001). A positive gradient for CHD, CVD, and all-cause mortality rates across E-ECG categories within 3, 4, or 5 MetS components was observed (P<.001 for all).
Conclusion:
Among men with MetS, an abnormal E-ECG response was associated with higher risk of all-cause, CVD, and CHD mortality. These findings underscore the importance of E-ECG tests to identify men with MetS who are at risk of dying.
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