Katzel L I, Sorkin K D, Colman E, Goldberg A P, Busby-Whitehead M J, Lakatta L E, Becker L C, Lakatta E G, Fleg J L
Department of Medicine, University of Maryland School of Medicine, Baltimore.
Am J Cardiol. 1994 Nov 1;74(9):869-74. doi: 10.1016/0002-9149(94)90578-9.
This study determined the risk factors for exercise-induced silent ischemia (SI) in 281 apparently healthy volunteers aged 40 to 87 years and compared their risk factor profiles with those of 132 patients with overt coronary artery disease (CAD). SI (concordant exercise-induced asymptomatic ST-segment depression on electrocardiography and perfusion defects on tomographic thallium-201 scintigraphy) was detected in 37 of 225 men (16%), versus 2 of 56 women (4%, p < 0.05). The prevalence of SI increased with age from 6% in men aged < 55 years to 18% in men aged 55 to 70 years, and to 25% in men aged > 70 years (p < 0.001). Compared with the 118 men with concordant normal exercise electrocardiogram and thallium scan (normals), men with SI were older (p < 0.001), and had a higher waist-to-hip ratio (p < 0.005), higher plasma triglyceride levels (p < 0.001), and lower high-density lipoprotein (HDL) cholesterol levels (p < 0.001). In stepwise logistic regression analysis, age, waist-to-hip ratio, and HDL levels were independent predictors of SI in men. Compared with 108 men with overt CAD, men with SI were younger (67 +/- 2 vs 73 +/- 1 years, p < 0.001) but had similar plasma lipids and waist-to-hip ratio. Thus, older age, male gender, abdominal obesity, and reduced HDL levels--all well-established risk factors for overt CAD--were risk factors for exercise-induced SI in these asymptomatic volunteers.
本研究确定了281名年龄在40至87岁之间的明显健康志愿者运动诱发无症状心肌缺血（SI）的危险因素，并将他们的危险因素特征与132例显性冠心病（CAD）患者进行了比较。在225名男性中有37名（16%）检测到SI（心电图上运动诱发的无症状ST段压低与断层铊-201闪烁显像上的灌注缺损一致），而56名女性中有2名（4%，p<0.05）。SI的患病率随年龄增加，在年龄<55岁的男性中为6%，在55至70岁的男性中为18%，在年龄>70岁的男性中为25%（p<0.001）。与118名运动心电图和铊扫描结果均正常的男性（正常组）相比，患有SI的男性年龄更大（p<0.001），腰臀比更高（p<0.005），血浆甘油三酯水平更高（p<0.001），高密度脂蛋白（HDL）胆固醇水平更低（p<0.001）。在逐步逻辑回归分析中，年龄、腰臀比和HDL水平是男性SI的独立预测因素。与108名显性CAD男性相比，患有SI的男性更年轻（67±2岁对73±1岁，p<0.001），但血浆脂质和腰臀比相似。因此，年龄较大、男性、腹部肥胖和HDL水平降低——所有这些都是显性CAD的公认危险因素——是这些无症状志愿者运动诱发SI的危险因素。
