Chronotropic response to exercise testing is associated with carotid atherosclerosis in healthy middle-aged men

Aims: Chronotropic incompetence, an attenuated heart rate (HR) response to exercise, is an independent predictor of cardiovascular mortality, but it is not known whether chronotropic incompetence is related to carotid atherosclerosis. The association between chronotropic incompetence and carotid atherosclerosis in 8567 (age 47.6 ± 8.8 years) healthy men was examined. Methods and results: Chronotropic incompetence was defined as the failure to achieve 85% of the age-predicted maximal HR (APMHR), <80% HR reserve (HRR), and chronotropic response index (CRI). Carotid atherosclerosis was defined, using B-mode ultrasonography, as stenosis >25% and/or intima-media thickness (IMT) of >1.2 mm. In multivariable adjusted logistic regression models, the subjects who achieved less than 85% of APMHR exhibited an odds ratio (OR) of 1.72 [95% confidence intervals (CI): 1.32-2.22] for carotid atherosclerosis. Subjects with <80% of HRR were 1.45 (95% CI: 1.14-1.84) times more likely to have carotid atherosclerosis after multivariate adjustment. Also, the OR of carotid atherosclerosis across quartiles of CRI (highest to lowest) was 1.51 (95% CI: 1.10-2.09) after multivariate adjustment. Conclusion: These results suggest that the chronotropic response to exercise is associated with carotid atherosclerosis, independent of the established risk factors in healthy men, which could contribute to high incidence of cardiovascular diseases in subjects with chronotropic incompetence.