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To the Editor: Dr Aktas and colleagues¹ concluded that the Framingham Risk Score performed worse than the European SCORE in predicting all-cause mortality, and that abnormal exercise testing (especially impaired functional capacity or heart rate recovery) predicted clinically important increased mortality for participants in the highest tertile of risk predicted by the European SCORE. They suggest that an elevated European SCORE may be helpful in determining which asymptomatic patients to refer for exercise testing and that if exercise testing is done, it should be limited to the highest risk group.

These conclusions may lead to inappropriate selection of patients for noninvasive cardiac testing. There is evidence that for cardiovascular disease, asymptomatic intermediate risk persons with abnormal results on a noninvasive test for atherosclerosis have a significantly greater risk for future events.² Therefore, for this population, abnormal test results can serve as a basis for recommending intensive risk-reducing medical therapy. . . . [Full Text of this Article]

Stephen D. Persell, MD, MPH
spersell@nmff.org
Division of General Internal Medicine
Feinberg School of Medicine
Northwestern University
Chicago, Ill