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To the Editor: Dr Aktas and colleagues¹ report that impaired functional capacity during exercise stress testing and abnormal heart rate recovery, when combined with the European Systematic Coronary Risk Evaluation (SCORE), may be useful for stratifying mortality risk in asymptomatic patients. A previous study found that resting heart rate before exercise, adjusted for age and sex, was predictive of all-cause mortality in individuals referred for coronary artery disease (hazard ratio [HR], 1.29; P<.001), although the effect was weaker when additionally adjusted for heart rate recovery (HR, 1.14; P = .07).² Resting heart rate has been found to be associated with cardiovascular mortality and total mortality in other prospective studies.^3-4 Given this, it would be interesting to know the impact of the inclusion of resting heart rate as a variable in the Cox proportional hazards model that was developed in the present study.

Paolo Palatini, MD
palatini@unipd.it
Department of Clinical and Experimental Medicine
University of Padova
Padua, Italy

1. Aktas MK, Ozduran V, Pothier CE, Lang R, Lauer MS. Global risk scores and exercise testing for predicting all-cause mortality in a preventive medicine program. JAMA. 2004;292:1462-1468. FREE FULL TEXT 2. Lauer MS, Cole CR. Recovery of heart rate after exercise. N Engl J Med. 2000;342:662-663. FREE FULL TEXT 3. Goldberg RJ, Larson M, Levy D. Factors associated with survival to 75 years of age in middle-aged men and women: the Framingham Study. Arch Intern Med. 1996;156:505-509. FREE FULL TEXT 4. Palatini P, Thijs L, Staessen J, et al. Predictive value of clinic and ambulatory heart rate for mortality in elderly subjects with systolic hypertension. Arch Intern Med. 2002;162:2313-2321. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293:159.

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