Context The value of exercise testing in women has been questioned.
Objective To determine the prognostic value of exercise testing in a population-based
cohort of asymptomatic women followed up for 20 years.
Design and Setting Near-maximal Bruce-protocol treadmill test data from the Lipid Research
Clinics Prevalence Study (1972-1976) with follow-up through 1995.
Participants A total of 2994 asymptomatic North American women, aged 30 to 80 years,
without known cardiovascular disease.
Main Outcome Measures Cardiovascular and all-cause mortality.
Results There were 427 (14%) deaths during 20 years of follow-up, of which 147
were due to cardiovascular causes. Low exercise capacity, low heart rate recovery
(HRR), and not achieving target heart rate were independently associated with
increased all-cause and cardiovascular mortality. There was no increased cardiovascular
death risk for exercise-induced ST-segment depression (age-adjusted hazard
ratio, 1.02; 95% confidence interval [CI], 0.57-1.80; P = .96). The age-adjusted hazard ratio for cardiovascular death for
every metabolic equivalent (MET) decrement in exercise capacity was 1.20 (95%
CI, 1.18-1.30; P<.001); for every 10 beats per
minute decrement in HRR, the hazard ratio was 1.36 (95% CI, 1.19-1.55; P<.001). After adjusting for multiple other risk factors,
women who were below the median for both exercise capacity and HRR had a 3.5-fold
increased risk of cardiovascular death (95% CI, 1.57-7.86; P = .002) compared with those above the median for both variables.
Among women with low risk Framingham scores, those with below median levels
of both exercise capacity and HRR had significantly increased risk compared
with women who had above median levels of these 2 exercise variables, 44.5
and 3.5 cardiovascular deaths per 10 000 person-years, respectively (hazard
ratio for cardiovascular death, 12.93; 95% CI, 5.62-29.73; P<.001).
Conclusion The prognostic value of exercise testing in asymptomatic women derives
not from electrocardiographic ischemia but from fitness-related variables.