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Cardiac Stress Testing
When should you consider it?

I have received a number of question as to the advisability of supervised cardiac stress testing (cardiac treadmill) to identify assymptomatic coronary artery disease - either to get clearance to safely begin an exercise program or prior to getting into competitive cycling. Regular exercise does not eliminate the risk of cardiac disase - although it does decrease your risks - so even those who exercise regularly can benefit from cardiac stress testing.

First, the role of the stress treadmill before initiating an exercise training program. This is a complex question as an answer needs to take into account a number of variables such as age and the presence of various "cardiac risk factors" such as high blood pressure, family history, and elevated cholesterol/lipids. There is a comprehensive review of the subject at the American Heart Association website which covers both the revised standards and guidelines for the exercise testing itself as well as guidelines for training individuals with and without clinical manifestations of cardiovascular disease. The bottom line is that all of us should have, as a minimum, a good physical exam including a cholesterol/lipid check and blood pressure assessment before ramping up on an exercise program. With that baseline information, you and your physician can make a reasoned decision on whether you should have a treadmill as well. In general, a sedentary individual who at the age of 40 years decides to enter an exercise program of a higher intensity than walking at 50% to 60% of maximum heart rate reserve should undergo anexercise test. Testing is also recommended for younger individuals with coronary risk factors or a strong family history of coronary artery disease (CAD).

Next let's consider the role of stress testing in someone already in shape and exercising regularly. This question clearly outlines the dilemma: "I am 47-yrs old and ride approximately 5,000 per year at semi-competitive levels. As I get older, I have questions about assessing my cardio-vascular fitness, particularly as I push myself to higher levels of performance each year. Would it be advisable to obtain stress testing by a cardiologist?"

The answer is to found in an article by BJ Maron et al in Circulation 16;103(2):327-334 2001 Jan. To quote, " is recommended that those masters athletes having amoderate-to-high cardiovascular risk profile for coronary arterydisease, who desire to enter vigorous competitive situations, undergo exercise testing. Specifically, this risk profile would include men more than 40 to 45 years old or women more than 50 to 55 years old (or postmenopausal) with 1 or more independent coronary risk factors. These include the following: hypercholesterolemia or dyslipidemia (total cholesterol >200 mg/dL; elevated low-density lipoprotein [LDL] cholesterol [>130 mg/dL]; low high-density lipoprotein [HDL] cholesterol [<35 mg/dL for men; <45 mg/dL for women]); systemic hypertension (systolic blood pressure >140 mm Hg or diastolic pressure >90 mm Hg); current or recent cigarette smoking; diabetes mellitus (fasting plasma glucose 126 mg/dL or treatment with insulin or oral hypoglycemics); or history of myocardial infarction or sudden cardiac death in a first-degree relative <60 years old. In addition, an exercise test is recommended for those masters athletes of any age with symptoms suggestive of underlying coronary disease and for those 65 years old even in the absence of risk factors and symptoms."


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