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Prognostic value of risk factors and exercise testing in men with atypical chest pain
Insights
Conventional risk factors like smoking, high blood pressure, and high cholesterol, along with exercise predictors such as functional aerobic impairment and ST depression, significantly predict coronary heart disease events in men with atypical chest pain.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Risk Stratification
Background:
- Atypical chest pain is a common clinical presentation requiring accurate risk assessment for coronary heart disease (CHD).
- Identifying individuals at high risk for primary coronary events is crucial for timely intervention.
Purpose of the Study:
- To evaluate the predictive value of conventional cardiovascular risk factors and exercise test responses in men with atypical chest pain.
- To determine if combining risk factors and exercise data improves prognostic accuracy.
Main Methods:
- Prospective follow-up of 551 men with atypical chest pain over 5-10 years.
- Analysis using Cox's regression model to assess the association of risk factors (smoking, blood pressure, hypercholesterolemia, family history) and exercise parameters (functional aerobic impairment, ST depression) with primary CHD events.
Main Results:
- Smoking, elevated systolic blood pressure, and hypercholesterolemia were significant predictors of CHD events (P < 0.05).
- Functional aerobic impairment and ST depression were the strongest exercise predictors (P < 0.001).
- A combination of risk factors and abnormal exercise findings significantly improved risk prediction, with 96% of men free of events at 9 years if they had neither risk factors nor abnormal exercise findings.
Conclusions:
- The evaluation of both conventional risk factors and exercise responses significantly enhances the prognostic assessment of men presenting with atypical chest pain.
- Risk stratification into low-, medium-, and high-risk groups is feasible in routine clinical practice.
Abstract:
Of 551 men with atypical chest pain enrolled in the Seattle Heart Watch Study, annual follow-up over a 5- to 10-year period identified 36 persons who experienced a primary coronary heart disease event. Only three events were fatal, and they were in men over the age of 50. Cox's regression model confirmed a significant association of the conventional risk factors of smoking (P = 0.03), elevated resting systolic blood pressure (P = 0.02) and hypercholesterolemia (P = 0.03) with primary coronary heart disease events. A count of these three variables was highly predictive (P = 0.002). A positive family history was not predictive. Functional aerobic impairment (P = 0.002) and ST depression (P = 0.0003) were the most useful exercise predictors. In men who had neither risk factors nor abnormal exercise predictors, the percentage free of coronary events at 9 years was 96% compared to 76% in men with one or more of the abnormal exercise findings (P less than 0.0001). Of men with only risk factors, 86% remained free of events at 9 years. This study demonstrates that the evaluation of both risk factors and exercise responses enhances the prognostic evaluation of men with atypical chest pain. The classification of men into low-, medium- and high-risk groups can be easily accomplished in office practice.