Exercise testing of healthy men in a new perspective: from diagnosis to prognosis.
OBJECTIVE
It has recently been suggested that exercise testing may be more valuable prognostically than it is diagnostically in apparently healthy subjects. We wanted to compare the accuracy of CHD risk assessment based on classical risk factors with an assessment also based on multiple exercise test parameters.


RESULTS
In 1972-75, 2014 apparently healthy men aged 40-60 had a symptom limited exercise test during a cardiovascular survey. Three hundred died from CHD during 26 years of follow-up. Compared to Cox regression models solely including classical risk factors (CRF), models also including multiple exercise test parameters (CRF+X) were clearly superior (P < 0.0001). Risk scores were computed based on the models. CRF and CRF+X risk scores often differed markedly; CRF+X scores were generally most reliable in both the high and low risk range. In smokers with cholesterol >6.5 mmol/l (n = 470), the CRF and CRF+X models identified 67 vs. 110 men at the highest CHD risk level according to European guidelines (34.2% vs. 38.2% CHD mortality). Three in five CRF+X-identified smokers with cholesterol >6.5 mmol/l had CHD mortality similar to the mean of all 2014 men.


CONCLUSIONS
Integration of multiple exercise test parameters and conventional risk factors improved CHD risk assessment substantially--especially in smokers with high cholesterol.
Erikssen
Gunnar
G
Department of Cardiology, Rikshospitalet, Sognsvannsveien 20, University of Oslo, 0027 Oslo, Norway. k-eriks@online.no
Bodegard
Johan
J
Bjørnholt
Jørgen Vildershøj
JV
Liestøl
Knut
K
Thelle
Dag S
DS
Erikssen
Jan
J
D000328:Adult; D002784:Cholesterol / Q000097:blood; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012907:Smoking / Q000009:adverse effects
D002784:Cholesterol