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Usefulness of exercise testing in the prediction of coronary disease risk among asymptomatic persons as a function of the Framingham risk score.
Circulation. 2004 Oct 05; 110(14):1920-5.Circ

Abstract

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 > or =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 > or =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 > or =20%). The evaluation of exercise test variables in women is limited, given our sample size and the few CHD events in women.

Authors+Show Affiliations

NHLBI's Framingham Heart Study, Framingham, Mass, USA. gary.balady@bmc.org.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15451778

Citation

Balady, Gary J., et al. "Usefulness of Exercise Testing in the Prediction of Coronary Disease Risk Among Asymptomatic Persons as a Function of the Framingham Risk Score." Circulation, vol. 110, no. 14, 2004, pp. 1920-5.
Balady GJ, Larson MG, Vasan RS, et al. Usefulness of exercise testing in the prediction of coronary disease risk among asymptomatic persons as a function of the Framingham risk score. Circulation. 2004;110(14):1920-5.
Balady, G. J., Larson, M. G., Vasan, R. S., Leip, E. P., O'Donnell, C. J., & Levy, D. (2004). Usefulness of exercise testing in the prediction of coronary disease risk among asymptomatic persons as a function of the Framingham risk score. Circulation, 110(14), 1920-5.
Balady GJ, et al. Usefulness of Exercise Testing in the Prediction of Coronary Disease Risk Among Asymptomatic Persons as a Function of the Framingham Risk Score. Circulation. 2004 Oct 5;110(14):1920-5. PubMed PMID: 15451778.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Usefulness of exercise testing in the prediction of coronary disease risk among asymptomatic persons as a function of the Framingham risk score. AU - Balady,Gary J, AU - Larson,Martin G, AU - Vasan,Ramachandran S, AU - Leip,Eric P, AU - O'Donnell,Christopher J, AU - Levy,Daniel, Y1 - 2004/09/27/ PY - 2004/9/29/pubmed PY - 2005/5/28/medline PY - 2004/9/29/entrez SP - 1920 EP - 5 JF - Circulation JO - Circulation VL - 110 IS - 14 N2 - 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 > or =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 > or =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 > or =20%). The evaluation of exercise test variables in women is limited, given our sample size and the few CHD events in women. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/15451778/Usefulness_of_exercise_testing_in_the_prediction_of_coronary_disease_risk_among_asymptomatic_persons_as_a_function_of_the_Framingham_risk_score_ L2 - https://www.ahajournals.org/doi/10.1161/01.CIR.0000143226.40607.71?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -