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Global Risk Score and Exercise Testing—Reply
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In Reply: Dr Palatini raises the question of the prognostic value of the resting heart rate. When considered alone, an increase in resting heart rate was predictive of all-cause mortality (HR for each 10-beat increase, 1.24 [95% confidence interval {CI}, 1.09-1.41]; P = .001). This association persisted after adjustment for European SCORE (adjusted HR, 1.26 [95% CI, 1.11-1.44]; P<.001). However, the predictive power of the resting heart rate was markedly attenuated after also accounting for the exercise test findings (adjusted HR, 1.14 [95% CI, 0.99-1.32]; P = .06) while functional capacity in particular remained a strong predictor of death (adjusted HR, 2.77 [95% CI, 1.85-4.15]; P<.001).
We agree with Dr Persell that there is no evidence that performing any kind of screening test for coronary disease improves clinical outcome, and noted that in our article. We believe strongly that large-scale randomized trials must be performed to answer this important public . . . [Full Text of this Article]
Mehmet K. Aktas, MD
Department of Medicine
Michael S. Lauer, MD
lauerm@ccf.org
Department of Cardiovascular Medicine
Cleveland Clinic Foundation
Cleveland, Ohio
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