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Screening for the detection of coronary artery disease by using the exercise tolerance test in a preventive medicine
R L Dunn1, R N Matzen, S VanderBrug-Medendorp
1Department of Preventive Medicine, Cleveland Clinic Foundation, OH 44195.
Insights
This study found that while age is a key factor in detecting coronary artery disease (CAD) using exercise tolerance tests, other risk factors like high cholesterol and chest pain history are also significant indicators.
Area of Science:
- Cardiology
- Preventive Medicine
- Diagnostic Testing
Background:
- Coronary artery disease (CAD) remains a leading cause of morbidity and mortality.
- Effective screening and diagnostic criteria are crucial for early detection and intervention.
- The exercise tolerance test (ETT) is a common tool for assessing cardiac function.
Purpose of the Study:
- To identify patients with coronary artery disease (CAD) using the exercise tolerance test (ETT).
- To develop improved criteria for ordering ETTs within a preventive medicine setting.
- To evaluate the effectiveness of age-based ETT referrals.
Main Methods:
- Retrospective analysis of 1,930 patients from the Cleveland Clinic Foundation's Preventive Medicine department undergoing ETTs.
- Patients were referred primarily based on age criteria (40 years, then every two years after 50).
- Comparison of patient groups with and without diagnosed CAD based on ETT results and clinical factors.
Main Results:
- Twenty-five cases (1.3%) of CAD were detected among the 1,930 patients.
- Age as the sole indication for testing identified 92% of CAD cases.
- Factors significantly associated with CAD included age >40, high total cholesterol (>240 mg/dL), high triglycerides (>250 mg/dL), cholesterol/HDL ratio >4.5, and chest pain history.
Conclusions:
- While age is a primary driver for ETT referrals in preventive medicine, incorporating additional risk factors can enhance detection rates.
- Current age-based criteria are effective but may miss cases that could be identified with a broader risk factor assessment.
- Further refinement of ETT referral guidelines is warranted to optimize CAD detection in asymptomatic populations.
Abstract:
We designed this study to identify patients with coronary artery disease (CAD), employing the exercise tolerance test, and to develop further criteria for ordering the exercise tolerance test in the preventive medicine population of the Cleveland Clinic Foundation. During 1987-1988 1,930 patients not known to have CAD were referred from the Department of Preventive Medicine for exercise tolerance tests as part of their periodic physical exams. We hypothesized that age was a major risk factor and ordered most (86.4%) tests on this basis: at age 40 and every two years after age 50. Twenty-five cases of CAD (25/1,930 or 1.3%) were found. One of 297 women was found to have CAD (0.3%). Seventeen patients were treated surgically and eight medically. Using age as an indication for testing detected 23 of 25 cases (92%). We compared the group with normal or nondiagnostic exercise tolerance tests and presumed not to have CAD (1,905 patients, median age 48) with the group with CAD (25 patients, median age 59). Age greater than 40, a total cholesterol level over 240 mg/dL, triglyceride level over 250 mg/dL, a total cholesterol to high-density lipoprotein ratio greater than 4.5, and a history of chest pain of any type were all significantly related to the presence of CAD. Testing men older than forty with two or more CAD risk factors, as has been recommended, would have resulted in finding five of the 25 cases (20%). Testing only patients who complained of any type of chest discomfort would have resulted in detecting 14 of the 25 cases (56%).(ABSTRACT TRUNCATED AT 250 WORDS)