Associations between First Year Medical Students' Lifestyles, Resting Blood Pressure, and Resting ECGs

Date of Award


Degree Type


Degree Name

Master of Science (MS)

First Advisor

Charlotte Greene, PhD, Chairperson

Second Advisor

Brian Balin, PhD

Third Advisor

Robert Barsotti, PhD


PURPOSE: There is considerable evidence that medical students experience adverse psychological outcomes based upon their responses to survey questionnaires. There also is an array of physiological studies targeting medical students, but few of these pertain to cardiovascular health. This is concerning because of other evidence that psycho-social stress has a profound impact on cardiovascular health. Furthermore, medical students also represent an age group that is currently under-represented within the context of cardiovascular treatment guidelines, as controlled studies that specifically focus on the 20-40 year age group are sparse. The lack of objective cardiovascular studies of medical students and their associated age group, the adverse psychological outcomes, and the association of psychological stress with cardiovascular health led to this question: "What would objective measurements reveal about the cardiovascular health of medical students and could any adverse changes uncovered be related to the medical curriculum?" While some psychological studies suggest that the adverse outcomes are directly related to the medical school curriculum, other evidence suggests that concurrent lifestyle factors may play a role.

OBJECTIVE: To identify if select behavioral lifestyle factors (alcohol consumption, aerobic exercise, caffeine consumption, self-perceived health issues, sleep, and strength exercise) and curriculum related lifestyle factors (anxiety related to exams, alone or group study, and hours of study) could be linked to cardiovascular adverse changes in blood pressures and electrocardiograms during the first year of medical school.

METHOD: Twenty five Medical students in the Philadelphia College of Osteopathic Medicine graduating class of 2017 were recruited and met inclusion criteria. Blood pressure and lifestyle factor surveys were obtained on a weekly basis and ECGs were recorded biweekly. All ECGs were read by a cardiologist. Participation by the cardiologist and the subjects was voluntary and without compensation. BP and Heart Rate data were statistically analyzed using ANOVA and the ECG analyses using Fisher Exact Test. Data obtained throughout the study was compared to the subjects' initial data gathered at the beginning of the academic year. Data was organized into the male gender category, the female gender category, and a category that combined the data for both genders.

RESULTS: There were statistically significant differences in the amount of caffeine consumption and systolic BP abnormalities (p=0.05), and also a statistically significant difference in the amount of strength training exercise and diastolic BP abnormalities (p=0.04) for the male gender category. There were statistically significant differences in the amount of strength training exercise and prevalence of early repolarization (p=0.01), and the amount of study hours and bradycardia (p= 0.04) for the female gender category. There were statistically significant differences between the amount of aerobic exercise and T wave inversions (p=0.03), anxiety level and voltage criteria for left ventriculum-hypertrophy (p=0.05), the amount of strength exercise and systolic BP abnormalities (p=0.02), the amount of strength exercise and diastolic abnormalities (p=0.004), the amount of study hours and bradycardia (p=0.034), and the amount of study hours and inverted T waves (p=0.008) for the combined gender category.

CONCLUSION: There were changes demonstrated in both blood pressure and ECGs demonstrated in association with both behavioral and curriculum lifestyle factors. Whether the behavioral habits that differed significantly from baseline were due to the curriculum cannot be determined from these preliminary analyses. However, these findings in this population are concerning with respect to younger adults as a discrete and unique population that may warrant closer scrutiny by the American Heart Association to determine whether a new category of recommendations for younger adults may be warranted with respect to blood pressure and heart rate parameters.

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