Usefulness of Exercise Testing in the Prediction of Coronary Disease Risk Among Asymptomatic Persons as a Function of the Framingham Risk Score

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, 45Ϯ9 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 Ն1 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 Ն20%, 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 Ն20%). The evaluation of exercise test variables in women is limited, given our sample size and the few CHD events in women.

The association between cardiorespiratory fitness and cardiovascular risk may be modulated by known cardiovascular risk factors

“…In those studies, the adjustment of RR was not made for BMI, and total cholesterol was not included in the model. In 2 other studies, 28,29 there were inconclusive results, which are discussed in more detail below. Mora et al 30 All models are adjusted for age and gender.…”

Value of exercise capacity and physical activity in the prevention of cardiovascular diseases—brief review of the current literature

“…Such a relationship has been found both in subjects referred to exercise testing because of increased risk of cardiovascular disease-the Framingham Risk Score (Balady et al 2004;D'Agostino et al 2001) and SCORE (Aktas et al 2004;Conroy et al 2003)-and in those referred because of widely accepted indications for such testing (Myers et al 2002). A relationship between exercise capacity and risk of death has also been found in the elderly (over 65 and over 75 years) (Goraya et al 2000;Jeger et al 2004) and in patients with established ischemic heart disease, including survivors of myocardial infarction, referred for rehabilitation programs (Kavanagh et al 2002).…”

“…A low level of physical activity and decreased exercise capacity are independent risk factors for cardiovascular and all-cause mortality (Aktas et al 2004;Balady et al 2004; Barengo et al 2004;Blair et al 1996;De Backer and De Bacquer 2004;Fowler-Brown et al 2004;Gulati et al 2003;Kampert et al 1996;Kavanagh et al 2002;Kleber 2004;Kurl et al 2003;Laukkanen et al 2004;Mark and Lauer 2003;Mieres et al 2005;Myers et al 2002;Thompson et al 2003). However, there is a lack of evidence that interventions aimed at increasing physical activity and exercise capacity can reduce this risk (Barengo et al 2004;De Backer et al 2003;Erikssen et al 2004;Kleber 2004;Lee et al 2001;Mark and Lauer 2003;Williams 2003).…”

The Hepatoprotective Effect of Olive Leaf Extract on Diabetic Pregnant Mice and Their Fetuses

“…Although exercise testing is proven to have prognostic value, studies examining the relationship between exercise, electrocardiography responses and coronary heart disease mortality risk in asymptomatic men with existing cardio vascular disease risk factors are inconsistent. Most of the studies have shown a positive association in high-risk subgroups (Laukknen et al, 2001;Balady et al, 2004;Bruce et al, 1980;Rywik et al, 2002). Exercise may be a therapeutic tool in a variety of patients with, or at risk for diabetes, but that like any therapy its effects must be thoroughly understood (Schnieder et al,1990;Wasserman et al, 1994;Devlin et al, 1995).…”