What is the clinical evidence from this study?

Study design: Editorial. Population: Apparently healthy obese men (n=170). Intervention: Exercise-induced silent myocardial ischemia vs. Normal exercise ECG. Primary outcome: Coronary artery disease endpoints (angina pectoris, coronary revascularization, nonfatal myocardial infarction, and coronary death).

What does this research mean for the field?

Exercise-induced silent myocardial ischemia and lower aerobic capacity independently predict future coronary artery disease events in apparently healthy obese older men. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

August 1, 1999Journal of the American Geriatrics Society

Silent Myocardial Ischemia and Low Aerobic Capacity: An Unlucky Combination

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Key result

Exercise-induced silent myocardial ischemia strongly predicted future CAD endpoints, occurring in 46% of men with ischemia versus 11% with normal exercise ECGs over 7.3 years.

Why the study?

Do exercise-induced silent myocardial ischemia and low aerobic capacity predict future coronary endpoints in apparently healthy obese older men?

Structured PICO

Do exercise-induced silent myocardial ischemia and low aerobic capacity predict future coronary endpoints in apparently healthy obese older men?

Population

170 apparently healthy obese men aged 46 to 79 years without conventional coronary risk factors, followed for a mean of 7.3 years.

Exposure

Exercise-induced silent myocardial ischemia (SI) and low aerobic capacity (VO2 max) assessed via treadmill exercise testing

Comparator

Normal exercise ECGs and higher aerobic capacity

Outcome

CAD endpoints (composite of angina pectoris, coronary revascularization, nonfatal myocardial infarction, and coronary death)composite

Main Result

Absolute Event Rate: 46% vs 11%

Limitations

Use of telephone and mail follow-up does not allow the detection of silent myocardial infarction.
Lack of clarity on whether telephone interviewers were blinded to baseline exercise test results.
Inclusion of coronary revascularization as a hard endpoint creates a strong bias to intervene based on abnormal test results.
Use of telephone and mail follow-up does not allow detection of silent myocardial infarction
Potential bias in telephone follow-up if interviewer was aware of baseline test results
Inclusion of coronary revascularization as a 'hard' endpoint when it may be driven by the test results (bias to intervene)
Failure to include blood pressure and lipid levels in the Cox model

Discussion

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Implication

Exercise-induced silent myocardial ischemia and low aerobic capacity are independent predictors of future coronary events in apparently healthy obese older men.

Cite This Study

Jerome L. Fleg (1999) conducted an editorial in Apparently healthy obese men (n=170). Exercise-induced silent myocardial ischemia vs. Normal exercise ECG was evaluated on Coronary artery disease endpoints (angina pectoris, coronary revascularization, nonfatal myocardial infarction, and coronary death). Exercise-induced silent myocardial ischemia strongly predicted future CAD endpoints, occurring in 46% of men with ischemia versus 11% with normal exercise ECGs over 7.3 years.

synapsesocial.com/papers/6aaa15bb0a88a9c60a4821e3 https://doi.org/10.1111/j.1532-5415.1999.tb01300.x

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Implication

Exercise-induced silent myocardial ischemia and low aerobic capacity are independent predictors of future coronary events in apparently healthy obese older men.

Silent Myocardial Ischemia and Low Aerobic Capacity: An Unlucky Combination

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Silent Myocardial Ischemia and Low Aerobic Capacity: An Unlucky Combination

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider