Evidence on harms was limited , but direct harms seemed minimal ( for resting ECG ) or small ( for exercise ECG ) .
BACKGROUND Coronary heart disease is the leading cause of death in adults .
Screening for abnormalities by using resting or exercise electrocardiography ( ECG ) might help identify persons who would benefit from interventions to reduce cardiovascular risk .
PURPOSE To up date the 2004 U.S. Preventive Services Task Force evidence review on screening for  resting or exercise ECG abnormalities in asymptomatic adults .
Major and minor ECG abnormalities in asymptomatic women and risk of cardiovascular events and mortality.
CONTEXT Data are sparse regarding the prevalence , incidence , and independent prognostic value of minor and /or major electrocardiographic ( ECG ) abnormalities in asymptomatic postmenopausal women . There is no information on the effect , if any , of hormonal treatment on the prognostic value of the ECG . OBJECTIVE To examine association of minor and major baseline and incident ECG abnormalities with long-term cardiovascular morbidity and mortality . DESIGN , SETTING , AND PARTICIPANTS Post-hoc analysis of the estrogen plus progestin component of the Women 's Health Initiative study , a r and omized controlled primary prevention trial of 14 749 postmenopausal asymptomatic women with intact uterus who received 1 daily tablet containing 0.625 mg of oral conjugated equine estrogen and 2.5 mg of medroxyprogesterone acetate or a matching placebo . Participants were enrolled from 1993 to 1998 , and the estrogen plus progestin trial was stopped on July 7 , 2002 . MAIN OUTCOME MEASURES The Novacode criteria were used to define minor , major , and incident ECG abnormalities . Cardiovascular end points included incident coronary heart disease ( CHD ) and cardiovascular disease ( CVD ) events . RESULTS Among women with absent ( n = 9744 ) , minor ( n = 4095 ) , and major ( n = 910 )  ECG abnormalities  , there were 118 , 91 , and 37 incident CHD events , respectively . The incident annual CHD event rates per 10 000 women with absent , minor , or major ECG abnormalities were 21 ( 95 % confidence interval [ CI ] , 18 - 26 ) , 40 ( 95 % CI , 32 - 49 ) , and 75 ( 95 % CI , 54 - 104 ) , respectively . After 3 years of follow-up , 5 % of women who had normal ECG at baseline developed new ECG abnormalities with an annual CHD event rate of 85 ( 95 % CI , 44 - 164 ) per 10 000 women . The adjusted hazard ratios for CHD events were 1.55 ( 95 % CI , 1.14 - 2.11 ) for minor baseline , 3.01 ( 95 % CI , 2.03 - 4.46 ) for major baseline , and 2.60 ( 95 % CI , 1.08 - 6.27 ) for incident ECG abnormalities . There were no significant interactions between hormone treatment assignment and ECG abnormalities for risk prediction of cardiovascular end points . For prediction of CHD events , the addition of ECG findings to the Framingham risk score increased from 0.69 to 0.74 the area under the receiver operating characteristic curve . Similar findings were found for incident CVD events . CONCLUSIONS Among asymptomatic postmenopausal women , clinical ly relevant baseline and incident ECG abnormalities are independently associated with increased risk of cardiovascular events and mortality , and the information is incremental to the established method of risk stratification . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00000611
Evidence on harms was limited , but direct harms seemed minimal ( for resting ECG ) or small ( for exercise ECG ) .
BACKGROUND Coronary heart disease is the leading cause of death in adults .
Screening for abnormalities by using resting or exercise electrocardiography ( ECG ) might help identify persons who would benefit from interventions to reduce cardiovascular risk .
PURPOSE To up date the 2004 U.S. Preventive Services Task Force evidence review on screening for  resting or exercise ECG abnormalities in asymptomatic adults .