| Author, Year (Reference) |
Sample | Exclusion Criteria | Mean Years of Followup | Test | Definition of Abnormal Test Result | Prevalence of Predictor | Cumulative Event Rate | Relative Risk for CHD Events with Positive Test | Sensitivity for CHD Events | Positive Predictive Value of Abnormal Test | Relative Risk Adjusted for the Following Variables |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Ekelund et al., 198835 | 3,106 (healthy white men) in Lipid Research Clinics Prevalence Survey in united States and Canada Age range: 30-69 y 100% men |
Men with CVD symptoms or hypertension were analyzed separately | 8.5 | Modified submaximal Bruce | Heart rate during stage 2 of exercise tolerance test and exercise time | Increase of 2 SD in stage 2 heart rate |
0.26-1.69%b | 3.2 (1.5-6.7) 2.8 (1.3-6.1) |
NR | NR | Age, smoking, HDL cholesterol level, LDL cholesterol level, systolic blood pressure |
| Lauer et al., 199644 | 1,575 subjects in Framingham Offspring Study (predominantly white) Mean age: 43 y 100% men |
Prevalent CAD, inability to reach stage 2 in Bruce protocol, use of beta-blockers at time of exercise tolerance test | 7.7 | Submaximal Bruce | Failure to achieve age- and sex-predicted target heart rate on exercise tolerance test | 21% | 3% for those who reached target heart rate (all cause death) 6% for those who failed to reach heart ratec |
No significant association of predictor with all cause death 1.75 |
46% | 14% | Age, ST-segment response, physical activity, BMI, smoking, hypertension, hypertension medication, diabetes mellitus, total cholesterol level/HDL cholesterol level |
Wei et al., 199948 Blair et al., 199649 |
25,714 patients at a preventive med clinic in Texas Aerobics Center Longitudinal Study (>95% white), 10% of men with known CVD Mean age: 43.8 y 100% men |
History of cancer, BMI < 18.5 kg/m2, age < 20 y, or < 1 y of follow-up | 24 | Maximal treadmill | Low fitness using age-based MET cut points on exercise tolerance test | Normal weight: 10%
Overweight: 19% Obese: 51% |
Overall 1.7/1,000 person yearsb | Normal Weight |
36% 52% 79% |
4.6% 5.4% 3.4% |
Diabetes mellitus, cholesterol level, hypertension, current smoking, history of CVD, abnormal electrocardiogram at rest, age, BMI parental history of CVD, examination year |
| Cole et al., 200034 | 5,234 in Lipid Research Clinics Prevalence Survey in United States and Canada Mean age: >30 y 39% men |
Age < 30 y, use of beta-blockers, digoxin, antiarrhythmic agents or nitrates, history of cardiovascular disease, unable to reach stage 2 | 12 | Bruce or modified submaximal Bruce | Abnormal heart rate recovery defined as heart rate change of 42 beats/min or less from peak exercise to that measured 2 min later | 33% | Normal heart rate recovery 4% died Abnormal heart rate recovery 10% died |
1.95 1.55 |
54% | 10% | Age, sex, BMI, ethnicity, systolic blood pressure, hypertension medication, exercise habits, physical fitness, smoking, diabetes mellitus, lipids, ST-segment response, heart rate, chronotropic index, socioeconomic status |
| Jouven and Ducimetier 200045 | 6,101 French men in Paris civil service Age range: 42-53 y 100% men |
Known or suspected CVD, systolic blood pressure =180 at rest, or resting electrocardio-graphic abnormality | 23 | Bicycle ergometry | Premature ventricular complex constituting more than 10% of all ventricular depolarizations during exercise | 2.3% | Normal exercise tolerance test result 6.4% Abnormal exercise tolerance test result 16.1%b |
2.53
1.1 (0.8-1.5) |
5%b | 17%b | Age, BMI, heart rate, systolic blood pressure, tobacco use, level of physical activity, diabetes mellitus, total cholesterol, presence or absence of premature ventricular depolarizations before or after exercise |
| Morshedi-Meibodi et al., 200247 | 2,967 participants in Framingham Offspring Study Mean age ±SD: 43 ±10 y 47% men |
Prevalent CVD, chronic obstructive pulmonary disease, use of digoxin or beta-blockers, resting electrocardio-graphic abnormal-ities, inability to complete stage 1 of exercise | 15 | Submaximal Bruce | Heart rate recovery index - decrease in peak heart rate to 2 min of <42 beats/min | N/A | Overall 7.2% | 0.8 (0.5-1.1)c | NA | NA | Age, BMI, smoking, SBP, diastolic blood pressure, anti-hypertensive medication, diabetes mellitus, total cholesterol level, HDL cholesterol level, resting heart rate and peak heart rate |
| Rywik et al., 200221 | 1,083 participants in the Baltimore Longitudinal Study of Aging Mean age ±SD: 52 ±18 y 57% men |
History of angina or heart failure, Q wave on rest electrocardio-gram, valvular disease, use of antiarrhythmic drugs, inability to achieve 85% of max heart rate | 7.9 | Modified Balke | Duration of exercise | N/A | Overall 7% | 0.87 (0.79-0.96) |
NR | NR | Age, cholesterol, sex, ST-segment changes |
| Frolkis et al., 200346 | 29,244 persons referred to Cleveland Clinic for exercise tolerance testing Mean age ±SD: 56 ±11 y 70% men |
Age <30 y, symptomatic heart failure, use of digoxin, valvular disease, end-stagge renal disease, pacer, atrial fibrillation, heart block, frequent ventricular ectopic arrhythmia at rest, heart transplant, concurrent evaluation for an arrhythmia | 5.3 | Submaximal Bruce | Frequent ventricular ectopic arrhythmia (>7 ventricular premature contractions/min), ventricular bigeminy or trigeminy, ventricular couplets or triplets, ventricular tachycardia, ventricular flutter, torsade de pointes, or ventricular fillibration | No ventricular ectopic arrhythmia Frequent ventricular ectopic arrhythmia during recovery 2% Frequent ventricular ectopic arrhythmia during exercise 3% |
5%c
11%c
9%c |
1.0
1.5 (1.1-1.9)c
1.1 (0.9-1.3)c |
3%
4% |
12%
9% |
Age, sex, diabetes mellitus, hypertension, smoking, previous CAD, medication use, BMI, resting heart rate, systolic blood pressure, ST- segment changes, chronotropic incompetence, abnormal heart rate recovery, peak exercise capacity |
| Mora et al., 200342 | 2994 women enrolled in the Lipid Research Clinics Prevalence Study Age range 30-80 y 0% men |
Pregnancy or significant cardiovascular disease | 20.3 | Maximal Bruce | Low exercise capacity (<7.5 METS) and low heart rate recovery (<55 beats/minute) | 31% | Normal and abnormal results on exercise tolerance test 5%b |
3.52 (1.57-7.86)b 2.11 (1.47-3.04)c |
71% | 11% | Age, smoking, diabetes, family history of premature heart disease, obesity, HDL cholesterol level, LDL cholesterol level, triglycerides, hypertension |
| Gulati et al., 200343 | 5721 women from the Chicago area (86% white) Mean age 52 y 0% men |
Self reported CHD, Percutaneous coronary intervention, coronary bypass surgery, congestive heart failure | 9 | Maximal Bruce | Exercise capacity, in METS | N/A | 3.2%c | 0.83 (0.78-0.89) |
- | - | Framingham Risk Score |
a Events are CHD events unless otherwise indicated. BMI = body mass index; CAD = coronary artery disease; CHD = coronary heart disease; CVD = cardiovascular disease; HDL = high-density lipoprotein cholesterol; LDL = low-density lipoprotein cholesterol; MET = metabolic equivalent; NA = not applicable; NR = not reported
b CHD death.
c All-cause death