BETHESDA, MD (Journal of the American College of Cardiology) -- Patients whose heart rates remain elevated after exercise testing are more than twice as likely to die within six years, making heart rate recovery a risk factor comparable to, and independent of, the severity of coronary artery disease as measured by angiography, according to a new study in the Sept. 3, 2003 issue of the Journal of the American College of Cardiology.
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September 5, 2003
By Howard LeWine, M.D.
Harvard Medical School
How does this article relate to me?
A simple measurement on a stress test is now just as important as the changes on your electrocardiogram (EKG) tracing. It gives your doctor added information about your risk of sudden death.
Exercise stress tests are used to help evaluate people with unexplained chest pain and to help determine the severity of coronary heart disease. The results are interpreted in conjunction with your symptoms. Until now, routine exercise testing in people without symptoms or without multiple risk factors has not been recommended because of the frequency of false positives that cause unnecessary worry and more testing, and false negatives that can result in less attention to sticking to a healthy lifestyle.
This one article should not immediately change current recommendations. However, if the findings are confirmed that a fall in heart rate of less than 12 beats per minute measured 60 seconds after exercise stops correlates with greater risk of sudden death, then the door is open to more aggressive preventive strategies.
What changes do I need to make?
Recent studies have confirmed that what doctors currently use to determine cardiac risk works well. All the new possibilities, like C-reactive protein and subfractions of LDL cholesterol, haven't yet improved on the standard risk factor profile:
- Not smoking
- Exercising and maintaining healthy body weight to help avoid type 2 diabetes
- Keeping blood pressure normal, preferably less than 120/80
- Striving for lower triglyceride and LDL cholesterol levels
- Paying extra attention to all of the above if you have an HDL cholesterol less than 40
How quickly your heart rate falls after you exercise makes sense as a predictor of sudden death. Exercise specialists and trainers use this measure regularly to help determine level of fitness. In general, the more quickly your heart rate falls when you either stop exercise or just slow down your pace or resistance, the fitter you are. Greater degrees of fitness correlate with less heart attacks and sudden death.
What can I expect in the future?
It is likely that this will become a useful test for measuring fitness ourselves, not just for those who go to the gym regularly. If you do not exercise, be careful about trying this without talking to your doctor at your next scheduled visit. If you already feel that your pulse races after walking short distances and continues to beat rapidly after you stop, then you need to give your doctor's office a call.
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Fitness
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