Exercise test predicts heart disease in "healthy" men

Exercise testing with a treadmill (ETT) can predict heart disease in men with no apparent symptoms, new research shows. Moreover, ETT provides useful information not obtained with the Framingham score, a commonly used system for calculating a person's risk of heart disease.

Although ETT is not usually recommended for people without symptoms, the new findings may help change that. "Our results suggest that exercise testing may be of benefit" in certain men with no symptoms of heart disease, lead author Dr. Gary J. Balady, from Boston University, said in a statement.

Due to limitations in the study's design, the researchers were unable to reach any firm conclusions in women, according to the report in Circulation: Journal of the American Heart Association.

The findings are based on a study of 3043 subjects who underwent ETT and then were followed for 18 years to assess the development of heart disease.

The researchers focused on three ETT findings as predictors of heart disease: an EKG change called an ST-segment depression; not reaching a goal heart rate; and exercise capacity.

The authors found that ST-segment depression and failure to reach a goal heart rate increased the risk of developing heart disease by 88 percent and 70 percent, respectively. Conversely, the risk of heart disease dropped as exercise capacity increased.

ETT was found to be particularly useful in men with a Framingham score that predicted a 20 percent or greater chance of developing heart disease in the next 10 years. In such men, ST-segment depression and failure to achieve target heart rate both more than doubled the risk of heart disease.

So should all men now undergo ETT to determine their risk of heart disease? Not necessarily, say the researchers.

The findings suggest that Framingham risk scores should be taken into account before performing ETT in men without symptoms of heart disease, because ETT testing appears to have the greatest yield for men with the highest Framingham risk scores, they add.

SOURCE: Circulation, 2004.