The maximal exercise ECG in asymptomatic men

Lead MC5 bipolar exercise ECG was obtained in 510 asymptomatic males, aged 40 to 65, utilizing the bicycle ergometer, with maximal stress in 71% of the subjects. “Ischemic changes” occurred in 61 subjects, the frequency increasing from 4% at age 40 to 45, to 20% at age 50 to 55, to 37% at age 61 to 65. Subjects having an ischemic type ECG change on exercise had more frequent minor resting ECG changes, more resting hypertension, and a greater incidence of high cholesterol values than subjects with a normal ECG response to exercise, but there was no difference in the incidence of obesity, low fitness, or high systolic blood pressure after exercise. Current evidence suggests that asymptomatic male subjects with an abnormal exercise ECG develop clinical coronary heart disease from 2.5 to over 30 times more frequently than those with a normal exercise ECG.     

Effect of treadmill exercise testing on serum enzymes and the resting electrocardiogram.

Fifty-three adult male patients with chest pain underwent treadmill exercise stress testing according to the Bruce protocol. The resting 12-lead electrocardiogram (ECG) and serum concentrations of glutamic oxaloacetic transaminase, lactic dehydrogenase creatine phosphokinase and alpha-hydroxybutyrate dehydrogenase were evaluated before, and at 1 and 20 hours after exercise. Twenty-eight subjects (53 percent) had a normal test result, 10 (19 percent) had ischemic ST -segment changes and anginal pain, and 15 (28 percent) were considered to have equivocal results because of an abnormal baseline ECG or the concurrent administration of cardioactive medication. In contrast to earlier reports, no significant changes in the serum enzyme values were seen in any of the three groups orin any individual subject, nor were ECG changes detected after recovery from exercise. The diagnostic evaluation of the exercise ECG must depend upon the demonstration of ischemic ST -segment changes and not upon changes in concentrations of serum enzymes.     

Changes in serum creatine phosphokinase during submaximal exercise testing

The changes in creatine phosphokinase with exercise were studied in 70 subjects who had a submaximal exercise electrocardiogram carried out as part of their routine medical investigation. A significantly greater proportion of the subjects with a positive exercise ECG had a rise in CPK following exercise than did the subjects with a negative exercise ECG. The former had significantly lower initial CPK values, and this difference could be related to the different alteration of CPK with exercise in the two groups, for example by indicating a lower level of physical fitness in the group with positive exercise ECGs. However, the most likely explanation for the greater tendency of subjects with a positive exercise ECG to show a rise in CPK following exercise is greater CPK efflux from their ischemic myocardium.With refinements, measurement of CPK before and after exercise could be useful in helping to evaluate the diagnostic significance of the exercise ECG.     

Study protocol to investigate the effects of testosterone therapy as an adjunct to exercise rehabilitation in hypogonadal males with chronic heart failure

Background

Most studies on risk factors for development of coronary heart disease (CHD) have been based on the clinical outcome of CHD. Our aim was to identify factors that could predict the development of ECG markers of CHD, such as abnormal Q/QS patterns, ST segment depression and T wave abnormalities, in 70-year-old men, irrespective of clinical outcome.

Methods

Predictors for development of different ECG abnormalities were identified in a population-based study using stepwise logistic regression. Anthropometrical and metabolic factors, ECG abnormalities and vital signs from a health survey of men at age 50 were related to ECG abnormalities identified in the same cohort 20 years later.

Results

At the age of 70, 9% had developed a major abnormal Q/QS pattern, but 63% of these subjects had not been previously hospitalized due to MI, while 57% with symptomatic MI between age 50 and 70 had no major Q/QS pattern at age 70. T wave abnormalities (Odds ratio 3.11, 95% CI 1.18–8.17), high lipoprotein (a) levels, high body mass index (BMI) and smoking were identified as significant independent predictors for the development of abnormal major Q/QS patterns. T wave abnormalities and high fasting glucose levels were significant independent predictors for the development of ST segment depression without abnormal Q/QS pattern.

Conclusion

T wave abnormalities on resting ECG should be given special attention and correlated with clinical information. Risk factors for major Q/QS patterns need not be the same as traditional risk factors for clinically recognized CHD. High lipoprotein (a) levels may be a stronger risk factor for silent myocardial infarction (MI) compared to clinically recognized MI.     

The relationship between subclinical atherosclerosis and electrocardiographic abnormalities as biomarkers of cardiovascular risk

Electrocardiographic findings indicating myocardial disease, such as left ventricular hypertrophy or ST-T wave abnormalities, or the presence of coronary artery calcium, indicating atherosclerotic coronary artery disease, are both biomarkers of future cardiovascular (CV) risk. Although the risk factors for myocardial and coronary artery disease are similar, their concomitant expression has implications for CV disease screening and prevention programmes. The relationship between the resting 12-lead ECG and subclinical atherosclerosis measured as coronary artery calcium (CAC) with electron beam tomography was examined in 937 healthy participants (aged 40-50 years) enrolled in a CV risk screening study. Electrocardiograms and CAC were interpreted in blinded fashion, using standard criteria. An abnormal ECG was coded in 268 (28.6%) participants, most commonly left ventricular hypertrophy (3.1%), delayed precordial R wave transition (5.7%), T-wave abnormalities (10.0%) and intraventricular conduction delay (10.4%). Although abnormal ECG findings were associated with CV risk variables, the prevalence of any CAC was similar in subjects with any ECG finding (43 of 268, 16.0%) compared with those with normal ECGs (125 of 669, 18.7%, p=NS). In a logistic model controlling for CV risk factors including systolic blood pressure, low-density lipoprotein cholesterol (LDL-C), body mass index (BMI), glycosylated haemoglobin, race, age and gender, significant associations with CAC were found for LDL-C, race and BMI. There was no significant relationship between CAC and ECG abnormalities (odds ratio 0.80, 95% confidence interval 0.54-1.20). In conclusion, electrocardiographic abnormalities and subclinical calcified atherosclerosis were not significantly associated with each other in this middle-aged screening population. This suggests these two biomarkers may be complementary towards broader detection of latent CV risk.     

Electrocardiographic Changes Associated with Smoking and Smoking Cessation: Outcomes from a Randomized Controlled Trial

Introduction

Cardiovascular disease (CVD) can be detected and quantified by analysis of the electrocardiogram (ECG); however the effects of smoking and smoking cessation on the ECG have not been characterized.

Methods

Standard 12-lead ECGs were performed at baseline and 3 years after subjects enrolled in a prospective, randomized, placebo-controlled clinical trial of smoking cessation pharmacotherapies. ECGs were interpreted using the Minnesota Code ECG Classification. The effects of (i) smoking burden on the prevalence of ECG findings at baseline, and (ii) smoking and smoking cessation on ECG changes after 3 years were investigated by multivariable and multinomial regression analyses.

Results

At baseline, 532 smokers were (mean [SD]) 43.3 (11.5) years old, smoked 20.6 (7.9) cigarettes/day, with a smoking burden of 26.7 (18.6) pack-years. Major and minor ECG criteria were identified in 87 (16.4%) and 131 (24.6%) of subjects, respectively. After adjusting for demographic data and known CVD risk factors, higher pack-years was associated with major ECG abnormalities (p = 0.02), but current cigarettes/day (p = 0.23) was not. After 3 years, 42.9% of subjects were abstinent from smoking. New major and minor ECG criteria were observed in 7.2% and 15.6% of subjects respectively, but in similar numbers of abstinent subjects and continuing smokers (p>0.2 for both). Continuing smokers showed significant reduction in current smoking (–8.4 [8.8] cigarettes/day, p<0.001) compared to baseline.

Conclusions

In conclusion, major ECG abnormalities are independently associated with lifetime smoking burden. After 3 years, smoking cessation was not associated with a decrease in ECG abnormalities, although cigarettes smoked/day decreased among continuing smokers.     

Exercise ECG changes in normal women

Submaximal and/or maximal exercise was carried out by 357 women without a history of cardiovascular disease, using a bicycle ergometer and/or treadmill while monitored by a bipolar ECG lead CM₅. In 40- to 60-year-old women the incidence of an ischemic ECG pattern during or after exercise ranged from 20 to 50%. Because clinical coronary disease can be expected in less than 10% of normal women followed for 16 years, most of these ECG changes were not considered to be due to occult coronary disease. At the present time exercise ECG changes in women cannot be used with any reliability as an aid in the diagnosis of chest pain or in screening normal female populations for coronary heart disease.     

Diagnostic value of maximal treadmill exercise electrocardiogram in predicting coronary artery disease for asymptomatic Chinese male subjects

The value of maximal treadmill exercise electrocardiogram (TEE) in predicting coronary artery disease was evaluated in a consecutive series of 168 asymptomatic Chinese males, aged 41 to 57 years (mean 53) during annual physical examinations. Their resting electrocardiograms (ECGs) showed no abnormal Q-waves. The end-point of TEE achieved the age-predicted maximal heart rate, and no subjects had classic angina pectoris during or after TEE. Thirty-five subjects had positive electrocardiographic changes defined as reversible horizontal or downsloping ST-segment depression greater than or equal to 1.0 mv which lasted greater than or equal to 0.08 sec. Exercise thallium-201 (T1-201) myocardial imaging was performed on all 35 subjects with positive TEE; 30 subjects (86%) demonstrated normal and 5 abnormal scintigrams. Sixteen of the 30 cases with normal T1-201 scans underwent coronary arteriography, of which 14 showed normal arteriograms and two showed a less than 49% stenosis of the luminal diameter in one major artery. Of the 5 cases with abnormal scintigrams, 4 were found to have greater than 50% stenoses in at least one major artery, and only one case had a less than 49% stenosis of the right coronary artery. We concluded that TEE alone for asymptomatic individuals provided limited value in diagnosing significant coronary artery disease, especially in areas of low prevalence.     

ZUNG 抑郁量表在冠心病诊断中的作用

目的：研究ZUNG量表在冠心病中的诊断作用。方法：对临床上所有怀疑冠心病的患者并行冠状动脉造影检查,术前给予ZUNG量表进行评价,同时对40健康人进行ZUNG量表评价,所有住院患者同时进行ECG,HOLTER检查及病史方面评价。结果：①在无高危因素和ECG客观检查正常的患者中ZUNG量表积分明显增高,且抑郁症的检出率高于其他各组,而冠心病检出率却低于除健康对照组的其他各组。②相关性分析：ZUNG量表积分与冠脉病变积分无相关关系。冠心病的患者中抑郁的检出率高于非冠心病组。存在高危因素的患者的抑郁检出率高于健康对照组。结论：ZUNG量表在冠心病的鉴别诊断,尤其排除抑郁导致胸痛,是一项比较有意义的检查手段。     

基于单个细胞动作电位计算心电:若干异常仿真心电图

根据构造的心脏电生理模型及提出的基于单细胞动作电位计算心电图的算法,介绍异常心电活动的描述方式及对若干异常心电图的仿真结果,包括心肌缺血、心肌梗死、房室传导阻滞、束支传导阻滞、以及房室旁路,并对这些心电图的 产生机制进行说明,算法及仿真结果表明,细胞间的跨缝隙连结电位差是产生场点电热进而产生各种心电图波形的原因。     

Combination of imaging modalities in a coronary artery fistula

A 35-year-old woman was referred for diagnostic evaluation of stitching pain under her left breast. The pain was not related to exercise. There were no cardiovascular risk factors. Physical examination, routine blood testing and chest X-ray were normal. Her ECG showed abnormal ST segments in III and aVF, and down-sloping ST segments with negative T waves in V₃ to V₄.     

Cationic concentrations and transmembrane fluxes in erythrocytes of humans during exercise

The effect of exercise on the intraerythrocyte cationic concentrations and transmembrane fluxes such as the Na+-K+-adenosinetriphosphatase (ATPase) pump, the Na+-K+ cotransport, and the Na+-Li+ countertransport system was studied in 11 normal male volunteers. All subjects performed an uninterrupted incremental exercise test on a bicycle ergometer, starting at an initial work load of 20% of the subjects' maximal exercise capacity, as determined in a pretest. The work rate was increased with an additional 20% each 6 min up to a final work load of 80%. Blood samples were taken at rest, at 60 and 80% of maximal exercise capacity, and 1, 2, 3, 4, 5, and 30 min after cessation of exercise. At moderate exercise (60% of maximal exercise capacity) the intraerythrocyte potassium concentration was not changed, but at severe exercise (80% of maximal exercise capacity) it was decreased. After exercise the intraerythrocyte potassium concentration returned to base line within 2 min. Exercise did not affect the intraerythrocyte concentrations of sodium and magnesium. The activity of the Na+-K+-ATPase pump and the Na+-K+ cotransport in the erythrocytes during and after exercise was no different from the resting level. The activity of the Na+-Li+ countertransport system on the contrary tended to decrease during exercise. It is concluded that exercise is accompanied by a leakage of potassium out of the erythrocytes without major alterations in the active red cell cationic fluxes.     

Target Value of Intraabdominal Fat Area for Improving Coronary Heart Disease Risk Factors

Objective: The goal of this study was to determine an intraabdominal fat (IF) area target value for improving coronary heart disease (CHD) risk factors in response to weight reduction. Research Methods and Procedures: Subjects were 279 obese Japanese women, 21 to 66 years old, who were divided into diet‐alone and diet‐plus‐exercise groups and participated in a 14‐week weight reduction program. The IF area was measured by computerized tomography scans. Systolic blood pressure ≥ 140 mm Hg, diastolic blood pressure ≥ 90 mm Hg, total cholesterol ≥ 5.70 mM, triglycerides ≥ 1.70 mM, and fasting plasma glucose ≥ 6.99 mM were defined as CHD risk factors. Results: The best trade‐off between sensitivity (probability of correctly detecting true positive) and specificity (probability of correctly detecting true negative) was found at 100 cm² pretreatment in combined data of the two groups. At posttreatment, although a slight difference was found in the target value between the treatment groups (60 cm² for diet alone and 50 cm² for diet plus exercise), the combined data showed that the best trade‐off occurred at 60 cm² (sensitivity and specificity were 0.55 and 0.63, respectively). The percentage of subjects having no CHD risk factors was significantly lower in the group that had large IF areas (≥60 cm²) (46%) compared with the group that had normal IF areas (<60 cm²) (65%). However, the percentage of subjects having multiple CHD risk factors was significantly greater in the group that had large IF areas (16%) compared with the group with normal IF areas (7%) at posttreatment. Discussion: Our longitudinal data suggest that obese Japanese women should reduce their IF areas to <60 cm² through weight reduction to improve CHD risk factors independent of treatment.     

Discriminant function analysis for evaluating the status of coronary heart disease risk

We investigated to discriminate those individuals categorized by 1. obesity, 2. hypercholesterolemia, 3. hypertension, 4. low maximal oxygen uptake, 5. an abnormal electrocardiogram reflecting ischemic patterns, and/or 6. real sedentary life, from relatively healthier individuals without coronary heart disease (CHD) risk factors. One hundred and six Japanese women, aged 30 to 72 years, all of whom were in the postabsorptive state, were recruited in a series of tests for anthropometric and physiologic profiles both during the resting state and during the submaximal-maximal cycling exercise. Subjects were categorized into two groups--those who possessed four or more of the above 1, 2, 3, 4, 5, and 6 (high-CHD-risk group, n = 15) and apparently healthy individuals with a minimum number of risk factors (low-CHD-risk group, n = 83). Analyses of the data revealed that a combination of 8 variables extracted from among original 25 variables accurately classified 13/15 (87%) of high-CHD-risk group and 77/83 (93%) of low-CHD-risk group (mean = 90/98 or 92%) into their respective groups. The 8 variables were double product, Katsura index, waist girth, chest girth, TG, TC, and skinfold thicknesses at the subscapular and abdominal sites. Subsequent t-test identified significant differences between groups not only for VO2max, SBP and TC but also for DBP, LDLC, TG, Hb, HR, and HRmax. Most of these differences were of a much greater magnitude compared to the existing difference in chronological age. These findings suggest the usefulness and importance of anthropometric and blood lipid variables in the explanation of differences in the health status between high-CHD-risk women and their counterparts.     

Calorie restriction or exercise: effects on coronary heart disease risk factors. A randomized, controlled trial

Coronary heart disease (CHD) risk factors and the risk of CHD increase with increased adiposity. Fat loss induced by negative energy balance improves all metabolic CHD risk factors. To determine whether fat loss induced by long-term calorie restriction (CR) or increased energy expenditure induced by exercise (EX) has different effects on CHD risk factors in nonobese subjects, we conducted a 1-yr controlled trial involving 48 nonobese subjects who were randomly assigned to one of three groups: CR, 20% CR diet (n = 18); EX, 20% increase in energy expenditure through daily exercise with no increase in energy intake (n = 18); or HL, healthy lifestyle guidelines (n = 10). Subjects were 29 women and 17 men aged 57 +/- 3 yr, with BMI 27.3 +/- 2.0 kg/m(2). Assessments included total body fat by DEXA, lipoproteins, blood pressure, HOMA-IR, C-reactive protein (CRP), and estimated 10-yr CHD risk score. Body fat decreased by 6.3 +/- 3.8 kg in CR, 5.6 +/- 4.4 kg in EX, and 0.4 +/- 1.7 kg in HL, which corresponded to reductions of 24.9, 22.3, and 1.2% of baseline body fat mass, respectively. These CR- and EX-induced energy deficits were accompanied by reductions in most of the major CHD risk factors, including plasma LDL-cholesterol, total cholesterol/HDL ratio, HOMA-IR index, and CRP concentrations that were similar in the two intervention groups. Data from the present study provide evidence that CR- and EX-induced negative energy balance result in substantial and similar improvements in the major risk factors for CHD in normal-weight and overweight middle-aged adults.     

Application of determined NT-proBNP in physical standardized exercise

Natriuretic peptides can be used as markers of heart failure, its severity and also in the differential diagnosis of dyspnea. Moreover, the dynamics of natriuretic peptides in physical standardized exercise may be used in the assessment of latent heart failure. AIM OF THE STUDY: Can determination of NT-proBNP be used in the diagnosis of exercise-induced ischemia or latent heart failure? 18 probands (10 men, 8 women) under study were risk persons with unspecified ECG, without signs of manifest heart failure. They were subjected to ergometric bike exercises up to the subjective maximum, SPECT myocardium with estimated ejection fraction of the left ventricle at peak ergometric exercise. The following parameters were followed-up: a) before ergometric exercise: NT-proBNP, CRP, TNF-alpha, Hb, Htc, lactate b) at subjective maximum: NT-proBNP, Hb, Htc, lactate c) 30 min after stopping the exercise: NT-proBNP d) 60 min after stopping the exercise: NT-proBNP. The volume blood changes were taken into account (estimation from the dynamics of Htc, Hb with calculation of metabolic changes of NT-proBNP). To evaluate the dynamics of NT-proBNP, the group was divided into subgroups according to the results obtained in ergometric exercises. RESULTS: initial values of NT-proBNP within normal limits (< 59 pmol/l, 500 ng/l) in 94%, the submaximal pulse rate was reached in 94%, ischemic changes in ECG were observed in 59%, typical clinical signs of heart ischemia were recorded in 35%. Signs of heart dysfunction according to SPECT were found in 47% and ischemic symptoms were observed in 43%. In general, the plasmatic volume decreased by 24% at maximal exercise. Lactate concentration in the plasma increased in all cases. Conversion of NT-proBNP into volume blood changes revealed that increased NT-proBNP occurred only in 22%. Differences between NT-proBNP before exercises and at maximal exercise prior and after correction into volume blood changes were statistically insignificant. 30 and 60 min after the exercise, no significant differences were found in NT-proBNP concentrations. Dividing into subgroups according to the results of ergometric exercises, showed no significant differences in NT-proBNP concentrations. Dynamics of NT-proBNP changes during and after ergometric exercises cannot be used for the diagnosis of exercise-induced heart failure. The high stability of NT-proBNP related to physical activity was confirmed.     

Cardiac involvement in Caucasian patients with pulmonary sarcoidosis

Background

Cardiac sarcoidosis (CS) is a potentially life-threatening condition. At present, there is no consensus with regard to the optimal non-invasive clinical evaluation and diagnostic procedures of cardiac involvement in patients with sarcoidosis. The aim of this study in a large homogenous Scandinavian sarcoidosis cohort was therefore to identify risk factors of cardiac involvement in patients with sarcoidosis, and the value of initial routine investigation with ECG and cardiac related symptoms in screening for CS.

Methods

In this retrospective study a cohort of 1017 Caucasian patients with sarcoidosis were included. They were all screened with ECG at disease onset and investigated for CS according to clinical routine.

Results

An abnormal ECG was recorded in 166 (16.3%) of the 1017 patients and CS was later diagnosed in 22 (13.2%) of them, compared to in one (0.1%) of the 851 sarcoidosis patients with a normal ECG (p < 0.0001). The risk for CS was higher in patients with a pathologic ECG combined with cardiac related symptoms (11/40) (27.5%) compared to those with pathologic ECG changes without symptoms (11/126) (8.7%) (p < 0.01). Furthermore, patients with Löfgren’s syndrome had a reduced risk for CS compared to those without (p < 0.05) the syndrome.

Conclusions

This study on an unusually large and homogenous sarcoidosis population demonstrate the importance of an abnormal ECG and cardiac related symptoms at disease onset as powerful predictors of a later diagnosis of cardiac sarcoidosis. In contrast, CS is very rare in subjects without symptoms and with a normal ECG. This knowledge is of importance, and may be used in a clinical algorithm, in identifying patients that should be followed and investigated extensively for the presence of CS.     

Breathing during exercise in subjects with mild-to-moderate airflow obstruction: effects of physical training.

In this study we explored the effects of physical training on the response of the respiratory system to exercise. Eight subjects with irreversible mild-to-moderate airflow obstruction [forced expiratory volume in 1 s of 85 +/- 14 (SD) % of predicted and ratio of forced expiratory volume in 1 s to forced vital capacity of 68 +/- 5%] and six normal subjects with similar anthropometric characteristics underwent a 2-mo physical training period on a cycle ergometer three times a week for 31 min at an intensity of approximately 80% of maximum heart rate. At this work intensity, tidal expiratory flow exceeded maximal flow at control functional residual capacity [FRC; expiratory flow limitation (EFL)] in the obstructed but not in the normal subjects. An incremental maximum exercise test was performed on a cycle ergometer before and after training. Training improved exercise capacity in all subjects, as documented by a significant increase in maximum work rate in both groups (P < 0.001). In the obstructed subjects at the same level of ventilation at high workloads, FRC was greater after than before training, and this was associated with an increase in breathing frequency and a tendency to decrease tidal volume. In contrast, in the normal subjects at the same level of ventilation at high workloads, FRC was lower after than before training, so that tidal volume increased and breathing frequency decreased. These findings suggest that adaptation to breathing under EFL conditions does not occur during exercise in humans, in that obstructed subjects tend to increase FRC during exercise after experiencing EFL during a 2-mo strenuous physical training period.     

Impact of heart failure and exercise capacity on sympathetic response to handgrip exercise

Peak oxygen uptake (VO(2 peak)) in patients with heart failure (HF) is inversely related to muscle sympathetic nerve activity (MSNA) at rest. We hypothesized that the MSNA response to handgrip exercise is augmented in HF patients and is greatest in those with low VO(2 peak). We studied 14 HF patients and 10 age-matched normal subjects during isometric [30% of maximal voluntary contraction (MVC)] and isotonic (10%, 30%, and 50% MVC) handgrip exercise that was followed by 2 min of posthandgrip ischemia (PHGI). MSNA was significantly increased during exercise in HF but not normal subjects. Both MSNA and HF levels remained significantly elevated during PHGI after 30% isometric and 50% isotonic handgrip in HF but not normal subjects. HF patients with lower VO(2 peak) (<56% predicted; n = 8) had significantly higher MSNA during rest and exercise than patients with VO(2 peak) > 56% predicted (n = 6) and normal subjects. The muscle metaboreflex contributes to the greater reflex increase in MSNA during ischemic or intense nonischemic exercise in HF. This occurs at a lower threshold than normal and is a function of VO(2 peak).     

Assessment of Global Coronary Heart Disease Risk in Overweight and Obese African‐American Women

Objective : To examine, with the use of national guidelines, coronary heart disease (CHD) risk with increasing BMI for primary prevention in urban African‐American women. Research Methods and Procedures : Participants were recruited for CHD risk factor screening from 20 churches as part of a larger study of nutrition and fitness (Project Joy). All participants had a demographic, smoking and medical history assessment, and the following measurements were taken: weight, height, waist circumference, blood pressure, lipid levels, and glucose. Three methods of defining risk, the Framingham Point Scoring System, a count of risk factors, and the presence of the multiple metabolic syndrome, based on the National Cholesterol Education Program Adult Treatment Panel III Report and BMI classes established by the Clinical Guidelines, were used. Results : A total of 396 women were eligible. Participants were 40 to 80 years of age and had marked excess prevalence of overweight and obesity (84%); 55% were obese. There was a linear increase in risk factors as BMI increased. Lipids did not differ significantly among BMI classifications. Seventeen percent of women had multiple metabolic syndrome. Eight percent and 16% of women in the normal and overweight BMI classes, respectively, had two or more modifiable risk factors. There was no difference in number of modifiable risk factors among the obese classes. The Framingham Point Scoring System assigned a <10% risk of a hard CHD event in 10 years to 97% of the women. Discussion : National risk assessment guidelines for primary prevention of CHD may not be adequate for overweight and obese urban African‐American women and require further study.