Exercise-enhanced assessment of risk factors for coronary heart disease in healthy men.

Exercise-enhanced risk assessment for subsequent morbidity and mortality due to coronary heart disease in 4105 asymptomatic healthy men (mean age of 44.6 +/- 7.9 years) is reported for in Seattle community practice. Annual incidence of primary coronary events ranges from 0.22% in 1792 men (43.6%) without conventional risk factors, to 0.42% in the majority of men (55.3%) with any risk factor(s) and less than two abnormal responses to maximal exercise. Among 44 men (1.1%) at high risk defined by any conventional risk factor(s) and any two or more abnormal responses to maximal exercise, annual incidence of primary coronary events is 5.2% (P less than 0.001). Of 1718 men under 60 years of age without conventional risk factors, 117 or 6.8% who developed ischemic ST depression with maximal exercise testing are false positive responders since no coronary event occurred during the next five years.