Charles A. Bertrand, M.D., FACP, DIM-CD (Ret.)
Associate Clinical Professor of Medicine at New York Medical College
and at the Medical University of South Carolina


STATISTICS -- A PLEASANT SURPRISE ! (STRESS TESTS)

Recently I heard a politician predict that by the year 2012 our national budget would be balanced and our debt eliminated. Isn't that just great? Do you believe it?

Let's think about the year 2012. Many of us will be dead by that time, perhaps even the politician. Who will remember what he said 12 years before? Is it possible that he might say a thousand other things in the intervening time period (the word concise is not in their lexicon). Or great events might occur, or we may have a depression -- -- and there are all sorts of other possibilities to blur his prediction.

When I read about a study in which 5 of 8 mice ,or rats, did well on a new medication I scratched my head in wonderment(the enthusiasts report first). Sir William Osler , a famous professor of medicine at Johns Hopkins almost a century ago and in a time where few medicines worked , said "hurry hurry use the new medicine before it stops working". He also said (to paraphrase) "if all the medicine in the world were dumped into the ocean it would be good for mankind.. and bad for the fish".

But finally I encountered an article based on statistics that impressed me -- and I think it's great. It is in the New England Journal of Medicine of September 21st, 2000 and the title is "Long-Term Outcome In Asymptomatic Men With Exercise Induced Premature Ventricular Depolarization". It was written by X.Jouven and others from the University of Paris and appears in volume 343,pages 826 to 833. I know that's quite a mouthful so let's explain it, because it is important! And it involves stress tests.

And what is a stress test? In our country patients exercise by walking on a treadmill. In France, where this research was done, a bicycle stress test is used. But basically it's the same test just a different form of exercise.

The subjects pulse ,blood pressure and electrocardiogram (EKG) are measured before, during and after exercise... We especially observe the EKG -for example, if an EKG is normal at rest and then becomes abnormal during exercise the test is considered positive ( ie it shows an abnormal response).

This study was done in France and 6101 middle age Frenchmen (civil servants) who had no cardiovascular disease had stress tests and one finding - the appearance of a different type of heart beat that originated in the lower part of the heart (called premature ventricular depolarization-also know as PVD's) was studied in order to determine its significance., if any.

Well, the study was conducted over a 23 year time span (and that really impresses me).Of the total group of 6101 men 138 had this finding induced by exercise and it appeared to be significant. And the reason is that this group of 138 had a greater chance for having a heart attack or dying from cardiovascular disease -- about 2.7 times greater than those who did not have these unusual heart beats during exercise.

And this was independent of other findings in the study. What to do with those who have a greater risk for heart attacks or sudden cardiac death.

The answer may be found in cardiac risk factor prevention --ie. to prevent heart attacks -perhaps better phrased to promote cardiovascular health. Don't smoke, keep your weight in the normal range,maintain a normal blood pressure (have it checked at least once or twice a year even if normal), monitor your cholesterol levels and keep cholesterol within the desired or normal rangs, exercise on a regular basis. These patients should see their doctors regularly and have studies done per the recommendations of their physicians.



The advice provided on this website is intended to be general in nature and should not be relied upon for specific treatment. If you need personal medical attention please contact your physician.


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