Published online before print September 27, 2004, doi: 10.1161/01.CIR.0000143226.40607.71
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2004;110:1920-1925.)
© 2004 American Heart Association, Inc.
Coronary Heart Disease |
Usefulness of Exercise Testing in the Prediction of Coronary Disease Risk Among Asymptomatic Persons as a Function of the Framingham Risk Score
From NHLBI’s Framingham Heart Study, Framingham, Mass (M.G.L., R.S.V., E.P.L., C.J.O., D.L.); the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.J.O.); and the Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Mass (G.J.B.).
Correspondence to Gary J. Balady, MD, Section of Cardiology, Boston Medical Center, 88 E Newton St, Boston, MA 02118. E-mail gary.balady{at}bmc.org
Received July 15, 2003; de novo received February 9, 2004; revision received June 25, 2004; accepted June 29, 2004.
Background— The purpose of this study is to determine the usefulness of exercise treadmill testing (ETT) among asymptomatic persons in predicting coronary heart disease (CHD) events over and above the Framingham CHD risk score.
Methods and Results— Subjects included 3043 members of the Framingham Heart Study offspring cohort without CHD (1431 men and 1612 women; age, 45±9 years) who underwent ETT and were followed up for 18.2 years. The risk of developing CHD was evaluated relative to 3 exercise test variables: (1) ST-segment depression 
1 mm, (2) failure to achieve target heart rate (THR) of 85% predicted maximum, and (3) exercise capacity. In multivariable analyses that adjusted for age and Framingham CHD risk score, among men, ST-segment depression (hazard ratio [HR], 1.88; 95% CI, 1.21 to 2.91) and failure to achieve THR (HR, 1.70; 95% CI, 1.18 to 2.45) predicted higher CHD risk, whereas a greater exercise capacity predicted lower CHD risk (HR per MET, 0.94; 95% CI, 0.89 to 0.99). Although similar HRs were seen in women, those results were not statistically significant. Among men with 10-year predicted risk 20%, failure to reach THR and ST-segment depression both more than doubled the risk of an event (HR, 2.66 and HR, 2.11, respectively), and each MET increment in exercise capacity reduced risk by 13% (HR, 0.87).
Conclusions— Among asymptomatic men, ST-segment depression, failure to reach THR, and exercise capacity during ETT provided additional prognostic information in age- and Framingham risk score–adjusted models, particularly among those in the highest risk group (10-year predicted CHD risk of 20%). The evaluation of exercise test variables in women is limited, given our sample size and the few CHD events in women.
Key Words: exercise • risk factors • cardiovascular diseases
This article has been cited by other articles:
 |
|
 |
|
  G. W. Lyerly, X. Sui, T. S. Church, C. J. Lavie, G. A. Hand, and S. N. Blair Maximal Exercise Electrocardiography Responses and Coronary Heart Disease Mortality Among Men With Diabetes Mellitus Circulation, May 27, 2008; 117(21): 2734 - 2742. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Kokkinos, J. Myers, J. P. Kokkinos, A. Pittaras, P. Narayan, A. Manolis, P. Karasik, M. Greenberg, V. Papademetriou, and S. Singh Exercise Capacity and Mortality in Black and White Men Circulation, February 5, 2008; 117(5): 614 - 622. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Rosamond, K. Flegal, K. Furie, A. Go, K. Greenlund, N. Haase, S. M. Hailpern, M. Ho, V. Howard, B. Kissela, et al. Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 29, 2008; 117(4): e25 - e146. [Full Text] [PDF]
|
|
|
|
|
|
R. Arena, J. Myers, M. A. Williams, M. Gulati, P. Kligfield, G. J. Balady, E. Collins, and G. Fletcher Assessment of Functional Capacity in Clinical and Research Settings: A Scientific Statement From the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing Circulation, July 17, 2007; 116(3): 329 - 343. [Full Text] [PDF]
|
|
|
|
 |
|
 X. Sui, M. J. LaMonte, and S. N. Blair Cardiorespiratory Fitness as a Predictor of Nonfatal Cardiovascular Events in Asymptomatic Women and Men Am. J. Epidemiol., June 15, 2007; 165(12): 1413 - 1423. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Ingelsson, M. G. Larson, R. S. Vasan, C. J. O'Donnell, X. Yin, J. N. Hirschhorn, C. Newton-Cheh, J. A. Drake, S. L. Musone, N. L. Heard-Costa, et al. Heritability, Linkage, and Genetic Associations of Exercise Treadmill Test Responses Circulation, June 12, 2007; 115(23): 2917 - 2924. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Rosamond, K. Flegal, G. Friday, K. Furie, A. Go, K. Greenlund, N. Haase, M. Ho, V. Howard, B. Kissela, et al. Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, February 6, 2007; 115(5): e69 - e171. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Y. Jae, B. Fernhall, K. S. Heffernan, M. Kang, M.-K. Lee, Y.-H. Choi, and W. H. Park Chronotropic response to exercise testing is associated with carotid atherosclerosis in healthy middle-aged men Eur. Heart J., April 2, 2006; 27(8): 954 - 959. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. De Sutter, N. Van de Veire, and I. Elegeert Chronotropic incompetence: are the carotid arteries to blame? Eur. Heart J., April 2, 2006; 27(8): 897 - 898. [Full Text] [PDF]
|
|
|
|
|
|
T. Thom, N. Haase, W. Rosamond, V. J. Howard, J. Rumsfeld, T. Manolio, Z.-J. Zheng, K. Flegal, C. O'Donnell, S. Kittner, et al. Heart Disease and Stroke Statistics--2006 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, February 14, 2006; 113(6): e85 - e151. [Full Text] [PDF]
|
|
|
|
|
|
S. Mora, R. F. Redberg, A. R. Sharrett, and R. S. Blumenthal Enhanced Risk Assessment in Asymptomatic Individuals With Exercise Testing and Framingham Risk Scores Circulation, September 13, 2005; 112(11): 1566 - 1572. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Lauer, E. S. Froelicher, M. Williams, and P. Kligfield Exercise Testing in Asymptomatic Adults: A Statement for Professionals From the American Heart Association Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention Circulation, August 2, 2005; 112(5): 771 - 776. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. J. Balady Sudden Cardiac Death in Young Military Recruits: Guarding the Heart of a Soldier Ann Intern Med, December 7, 2004; 141(11): 882 - 884. [Full Text] [PDF]
|
|