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 .
Enhanced Risk Assessment in Asymptomatic Individuals With Exercise Testing and Framingham Risk Scores
Background —National Cholesterol Education Program Adult Treatment Panel III ( ATP III ) guidelines recommend the use of Framingham risk scores ( FRS ) for cardiovascular assessment of asymptomatic individuals . We hypothesized that risk prediction could be improved with 2 non-ECG exercise test measures , exercise capacity ( metabolic equivalents , or METs ) and heart rate recovery ( HRR ) . Methods and Results —An asymptomatic cohort with baseline treadmill tests ( n=6126 ; 46 % women , FRS < 20 % ) was followed up prospect ively for 20 years . Individuals with low ( median or less ) HRR or METs experienced 91 % of all cardiovascular disease ( CVD ) deaths ( 225/246 ) . After FRS adjustment , low HRR and METs individually were highly significant predictors of CVD death , but low HRR and METs together were associated with substantially higher risk ( adjusted hazard ratio compared with high HRR/high METs for women 8.51 , 95 % CI 3.65 to 19.84 ; for men , 3.53 , 95 % CI 2.03 to 6.15 ; P<0.001 for both ) . At 10-year follow-up , FRS-adjusted CVD death risk associated with low HRR/low METs was less than at 20 years but remained significant ( women 3.83 , 95 % CI 1.09 to 13.47 , and men 2.70 , 95 % CI 1.11 to 6.55 ) . The application of HRR/METs information to FRS assessment identified those at high risk ( > 0.5 % annual CVD mortality ) in half of women with FRS 6 % to 9 % and 10 % to 19 % and just under half of men with FRS 10 % to 19 % . Low HRR/low METs was also associated with an increased relative risk of CVD death in individuals with low-risk FRS ( FRS < 6 % in women and < 10 % in men ) , but absolute CVD mortality rates were low in this subgroup . Conclusions —Exercise testing may be a useful adjunct for clinical risk assessment in asymptomatic women with FRS 6 % to 19 % and men with FRS 10 % to 19 %
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 .