Assess risk before exercise testing
Assess risk before exercise testing
Boston, MA - Physicians should consider cardiac risk before ordering an exercise stress test, researchers say . Their findings, reported in a rapid access issue of Circulation online, show that exercise testing appears to benefit asymptomatic men at intermediate to high risk as defined by the Framingham risk score.
These results follow another study published last week in the Journal of the American Medical Association that encouraged physicians to skip unnecessary screening. As previously reported by heartwire, Dr Mehmet Aktas (Cleveland Clinic Foundation, OH) and colleagues sought to determine the prognostic value of exercise testing once baseline risks are known. They found that exercise testing combined with the European global risk score helps predict mortality in asymptomatic patients.
In the present analysis, lead author Dr Gary Balady (Boston Medical Center, MA) and colleagues wanted to determine the usefulness of an exercise test over and above the Framingham coronary heart disease risk score in predicting events among asymptomatic patients.
Balady and colleagues looked at 3043 members of the Framingham Heart Study offspring cohort without coronary heart disease who underwent an exercise treadmill test. The participants, aged 36 to 54, were followed for over 18 years. The risk of developing heart disease was evaluated according to three exercise test variables:
The researchers found that ST-segment depression or failure to reach target heart rate during exercise testing more than doubled the 10-year risk of a coronary event in men with high Framingham risk, compared with those who did not have these findings on the stress test. But increased exercise capacity predicted lower heart disease risk in the high-risk men.
Multivariable analysis among men*
*Adjusted for age and Framingham heart disease risk score
Balady and colleagues point out that although similar heart rates were seen in women, those results were not statistically significant.
They write, "Our study suggests that predicted coronary heart disease risk using the Framingham risk score should be taken into account before performing exercise treadmill tests in asymptomatic men, because such testing appears to have the greatest yield among those men with [the] highest risk."
Boston, MA - Physicians should consider cardiac risk before ordering an exercise stress test, researchers say . Their findings, reported in a rapid access issue of Circulation online, show that exercise testing appears to benefit asymptomatic men at intermediate to high risk as defined by the Framingham risk score.
These results follow another study published last week in the Journal of the American Medical Association that encouraged physicians to skip unnecessary screening. As previously reported by heartwire, Dr Mehmet Aktas (Cleveland Clinic Foundation, OH) and colleagues sought to determine the prognostic value of exercise testing once baseline risks are known. They found that exercise testing combined with the European global risk score helps predict mortality in asymptomatic patients.
In the present analysis, lead author Dr Gary Balady (Boston Medical Center, MA) and colleagues wanted to determine the usefulness of an exercise test over and above the Framingham coronary heart disease risk score in predicting events among asymptomatic patients.
Balady and colleagues looked at 3043 members of the Framingham Heart Study offspring cohort without coronary heart disease who underwent an exercise treadmill test. The participants, aged 36 to 54, were followed for over 18 years. The risk of developing heart disease was evaluated according to three exercise test variables:
ST-segment depression >1 mm.
Failure to achieve target heart rate of 85% predicted maximum.
Exercise capacity.
The researchers found that ST-segment depression or failure to reach target heart rate during exercise testing more than doubled the 10-year risk of a coronary event in men with high Framingham risk, compared with those who did not have these findings on the stress test. But increased exercise capacity predicted lower heart disease risk in the high-risk men.
Multivariable analysis among men*
Variables |
Hazard ratio |
95% CI |
ST-segment depression |
1.88 | 1.21-2.91 |
Failure to achieve target heart rate |
1.70 | 1.18-2.45 |
*Adjusted for age and Framingham heart disease risk score
Balady and colleagues point out that although similar heart rates were seen in women, those results were not statistically significant.
They write, "Our study suggests that predicted coronary heart disease risk using the Framingham risk score should be taken into account before performing exercise treadmill tests in asymptomatic men, because such testing appears to have the greatest yield among those men with [the] highest risk."
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