Sasaki S, Nakamura K, Uchida A, Fujita H, Itoh H, Nakata T, Takeda K, Nakagawa M
Second Department of Medicine, Kyoto Prefectural University of Medicine, Japan.
J Cardiovasc Risk. 1996 Feb;3(1):77-82.
Most epidemiologic studies that have evaluated coronary risk factors have measured either mortality or morbidity of coronary artery disease (CAD) as endpoints. However, earlier detection and elimination of coronary risk factors are crucial. We therefore performed Master's double (i.e. 1.5 min x 2 = 3 min) two-step exercise electrocardiograph (ECG) test in apparently healthy asymptomatic subjects (men, n = 2274; women, n = 959) to elucidate the risk factors for early-stage CAD or silent myocardial ischemia.
We examined the possible association of blood pressure at health screening and other suspected risk factors with exercise ECG test performance. The ischemic ECG response was determined by (1) > or = 0.5 mm horizontal or sagging S-T segment depression, (2) > or = 2.0 mm J-shaped S-T segment depression, or (3) T inversion in post-exercise ECG.
We found that 4.7% of men and 10.6% of women exhibited ischemic responses. Among males, the ischemic responders to the exercise ECG test had higher systolic and diastolic blood pressure. In addition, the male ischemic responders were older, had a higher obesity index, higher serum cholesterol, triglyceride, low-density lipoprotein (LDL)-cholesterol, protein, glucose, and uric acid levels, and a lower serum potassium level than normal responders. In contrast, the female ischemic responders to the exercise ECG test had higher systolic pressure, and higher serum cholesterol, LDL-cholesterol, and protein levels than normal responders. Mean blood pressure was correlated positively with most of the other coronary risk factors, and mild hypertensives and hypertensives had abnormal lipid, glucose, and uric acid levels in both sexes. A comparison of risk factors by age group revealed that only younger and middle-aged ischemic responders had higher blood pressure, serum cholesterol, and glucose levels than normal responders of both sexes, and that in older subjects all the differences between normal and ischemic responders became insignificant.
Elevated blood pressure at health screening, together with abnormal lipid and glucose metabolism, might be risk factors predicting early-stage or silent CAD. The elimination of these risk factors in younger men and women seems to be important.
大多数评估冠状动脉危险因素的流行病学研究都将冠状动脉疾病（CAD）的死亡率或发病率作为终点指标。然而，早期发现并消除冠状动脉危险因素至关重要。因此，我们对明显健康的无症状受试者（男性2274例，女性959例）进行了马斯特双倍（即1.5分钟×2 = 3分钟）两步运动心电图（ECG）测试，以阐明早期CAD或无症状心肌缺血的危险因素。
我们研究了健康筛查时的血压及其他可疑危险因素与运动心电图测试结果之间的可能关联。缺血性心电图反应通过以下标准判定：（1）水平或下垂型ST段压低≥0.5毫米；（2）J型ST段压低≥2.0毫米；或（3）运动后心电图出现T波倒置。
我们发现4.7%的男性和10.6%的女性出现缺血性反应。在男性中，运动心电图测试的缺血性反应者收缩压和舒张压更高。此外，男性缺血性反应者比正常反应者年龄更大，肥胖指数更高，血清胆固醇、甘油三酯、低密度脂蛋白（LDL）胆固醇、蛋白质、葡萄糖和尿酸水平更高，血清钾水平更低。相比之下，运动心电图测试的女性缺血性反应者收缩压更高，血清胆固醇、LDL胆固醇和蛋白质水平比正常反应者更高。平均血压与大多数其他冠状动脉危险因素呈正相关，男女轻度高血压患者和高血压患者的血脂、血糖和尿酸水平均异常。按年龄组对危险因素进行比较发现，只有年轻和中年缺血性反应者的血压、血清胆固醇和血糖水平高于男女正常反应者，而在老年受试者中，正常反应者与缺血性反应者之间的所有差异均不显著。
健康筛查时血压升高，以及脂质和葡萄糖代谢异常，可能是预测早期或无症状CAD的危险因素。消除年轻男性和女性的这些危险因素似乎很重要。
