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28-09-2009 | Cardiometabolic | Article

Exercise testing improves traditional CVD risk assessment by 50%

Abstract

Free abstract

MedWire News: Exercise testing significantly improves the accuracy of cardiovascular disease risk assessment when used alongside testing for traditional risk factors such as dyslipidemia, researchers believe.

Various markers of early cardiovascular disease have been identified, including carotid intima-media thickness (IMT), ankle-brachial blood pressure index, and C-reactive protein level. However, international guidelines recommend only lipid-focused tools such as the Framingham analysis to assess overall risk for a first coronary event in asymptomatic adults.

For the current study, Maxime Cournot (INSERM, Toulouse, France) and colleagues measured the additional prognostic value of physical examination, exercise testing, and arterial ultrasonography over that of conventional coronary risk factor assessments.

The trial involved 2561 adults with no history or symptoms of cardiovascular disease who were recruited after consulting physicians for problems not involving the cardiovascular system.

At the start of the study, all participants underwent a standard physical examination, cardiac exercise testing, and carotid and femoral ultrasonography. Standard information on lipid levels and other traditional cardiovascular risk factors was also collected. This information was then related to the incidence of cardiovascular disease measured over a median follow-up time of 6 years.

Statistical analysis allowed the researchers to calculate the incremental predictive value of each of the tests performed.

As reported in the American Heart Journal, performing an exercise test significantly improved the ability of traditional Framingham risk assessment to predict the risk for cardiovascular disease. Measuring IMT, and identifying femoral plaques also improved the accuracy of the Framingham assessment.

Specifically, when exercise testing, IMT, and femoral plaque analysis were all performed, they increased the power of the standard Framingham assessment to predict cardiovascular disease by 50% without increasing false-positive results.

“In conclusion, an abnormal physical examination, exercise test, or arterial ultrasonography provides incremental information on the risk for a first coronary event in asymptomatic adults,” the investigators write.

However, “intervention studies of screening strategies are needed before recommending any form of cardiovascular screening in asymptomatic patients,” the researchers caution.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

By Philip Ford