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Heart 2008;94:e14 doi:10.1136/hrt.2007.123471
  • Electronic pages
  • Coronary artery disease

Workload at the heart rate of 100 beats/min and mortality in middle-aged men with known or suspected coronary heart disease

  1. K P Savonen1,2,
  2. T A Lakka1,3,
  3. J A Laukkanen1,4,
  4. T H Rauramaa1,
  5. J T Salonen4,5,6,
  6. R Rauramaa1,2
  1. 1
    Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
  2. 2
    Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
  3. 3
    Institute of Biomedicine, Physiology, University of Kuopio, Kuopio, Finland
  4. 4
    School of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, Finland
  5. 5
    Inner Savo Health Centre, Suonenjoki, Finland
  6. 6
    Oy Jurilab Ltd, Kuopio, Finland
  1. Dr K P Savonen, Kuopio Research Institute of Exercise Medicine, Haapaniementie 16, 70100 KUOPIO, Finland; savonen{at}hytti.uku.fi
  • Accepted 14 August 2007
  • Published Online First 4 October 2007

Abstract

Objective: To investigate whether a workload which an individual is able to perform at the heart rate (HR) of 100 beats/min (WL100) independently predicts mortality in middle-aged men with known or suspected coronary heart disease (CHD).

Design: Prospective population-based study based on 365 middle-aged men with known or suspected CHD at baseline.

Results: During an average follow-up of 11.1 years, there were 75 deaths (20.5%). In Cox multivariable models mortality increased by 72% (95% CI 32% to 122%, p<0.001) with 1 SD (34 Watts) decrement in WL100 after adjustment for age, examination year, alcohol consumption, body mass index, cigarette smoking, cardiac insufficiency, history of myocardial infarction, diabetes, myocardial ischaemia during exercise test, serum low-density lipoprotein and high-density lipoprotein cholesterol, systolic and diastolic blood pressure at rest, testing protocol, and use of HR-lowering medication. The risk of death was 2.4 (95% CI 1.5 to 4.0, p<0.001) times higher in 130 men with WL100 <55 W than in 235 men with WL100 ≥55 W. In men using and not using HR-lowering medication the risk of death increased 72% (95% CI 14% to 163%, p = 0.01), and 54% (95% CI 14% to 108%, p = 0.005) with 1 SD decrement in WL100, respectively. WL100 improved the predictive power of the adjusted Cox models including other HR and exercise test variables.

Conclusions: WL100 predicts mortality in men with known or suspected CHD. The association of WL100 with mortality was not explained by other well-established HR and exercise test variables. WL100 is derived from a submaximal test which avoids the cardiovascular risks associated with a high-intensity exertion.

Footnotes

  • Funding: This study was supported by grants from the Ministry of Education in Finland (74/722/2003), the Finnish Cultural Foundation of Northern Savo, the Foundation of Sports Institutes in Finland, the Maire Taponen Foundation, the Mehiläinen Research Foundation, and the Paulo Foundation.

  • Competing interests: None.

  • Contributors: TAL was a Research Fellow of the Academy of Finland. KPS: conception and design; analysis and interpretation of data; drafting of the manuscript; final approval of the manuscript submitted. TAL: conception and design; analysis and interpretation of data; drafting of the manuscript; final approval of the manuscript submitted. JAL: conception and design; analysis and interpretation of data; critically revising the manuscript for important intellectual content; final approval of the manuscript submitted. THR: conception and design; analysis and interpretation of data; critically revising the manuscript for important intellectual content; final approval of the manuscript submitted. JTS: conception and design; critically revising the manuscript for important intellectual content; final approval of the manuscript submitted. RR: conception and design; analysis and interpretation of data; drafting of the manuscript; final approval of the manuscript submitted. KPS is the guarantor.

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