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(Stroke. 2005;36:820.)
© 2005 American Heart Association, Inc.

Original Contributions

Cardiac Power During Exercise and the Risk of Stroke in Men

S. Kurl, MD; J.A. Laukkanen, MD; L. Niskanen, MD, PhD; R. Rauramaa, MD, PhD, MSc; T.P. Tuomainen, MD; J. Sivenius, MD, PhD J.T. Salonen, MD, PhD, MScPH

From the Research Institute of Public Health (S.K., J.A.L., T.P.T., J.T.S.), University of Kuopio, Finland; Savolinna Central Hospital (J.A.L.), Finland; Department of Internal Medicine (L.N.), University Hospital of Kuopio, Finland; Kuopio Research Institute of Exercise Medicine and Department of Clinical Physiology and Nuclear Medicine (R.R.), University Hospital of Kuopio, Finland; Department of Neurology (J.S.), University Hospital of Kuopio, and Brain Research and Rehabilitation Centre Neuron, Kuopio, Finland; and Oy Jurilab, Ltd (J.T.S.), Kuopio, Finland.

Reprint requests to Sudhir Kurl, Research Institute of Public Health, University of Kuopio, PO 1627, 70211 Kuopio, Finland. E-mail sudhir.kurl{at}uku.fi

Background and Purpose— Low maximal oxygen uptake (VO_2max) has been shown to predict the risk of stroke. However, VO_2max does not take into account the differences in cardiac afterload between subjects. The aim of this study was to examine the relationship of exercise cardiac power (ECP), defined as a ratio of VO_2max with peak systolic blood pressure (SBP) during exercise, with the risk for stroke.

Methods— Population-based cohort study with an average follow-up of 12 years from eastern Finland. A total of 1761 men with no history of stroke or coronary heart disease at baseline participated. Among these men, 91 strokes occurred, of which 69 were attributable to ischemic causes.

Results— The relative risk of any stroke in men with low ECP (<10.3 mL/mm Hg) was 2.7 (95% CI, 1.2 to 6.0; P=0.01; P=0.02 for the trend across the quartiles), and the relative risk for ischemic stroke was 2.7 (95% CI, 1.1 to 7.0; P=0.03; P=0.04 for trend across the quartiles) compared with men having high ECP (>14.3 mL/mm Hg) during exercise after adjusting for age, examination year, cigarette smoking, alcohol consumption, body mass index, diabetes, serum total cholesterol level, energy expenditure of physical activity, exercise-induced myocardial ischemia, and the use of antihypertensive medication. After further adjustment for resting SBP, results were statistically nonsignificant.

Conclusions— Low ECP provides noninvasive and easily available measure for stroke risk. One of the most potential explanations for the association between ECP and the increased risk of stroke is an elevated afterload and peripheral resistance indicated by elevated SBP.

Key Words: blood pressure • epidemiology • risk factors • stroke • stroke, ischemic