How are risk factors for coronary artery disease (CAD) defined prior to treadmill stress testing?

Updated: Nov 21, 2018
  • Author: David Akinpelu, MD, FACP; Chief Editor: Eric H Yang, MD  more...
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Answer

Selected patients with multiple risk factors for CAD are at greater absolute risk for subsequent MI and death. Screening may potentially be helpful in patients who are at moderate risk, as defined by the available prognostic data from asymptomatic persons in the Framingham study.

For these purposes, define risk factors very strictly. Multiple risk factors are defined as hypercholesterolemia (cholesterol >240 mg/dL), hypertension (systolic blood pressure [SBP] >140 mm Hg or diastolic blood pressure [DBP] >90 mm Hg), smoking, diabetes, and family history of heart attack or sudden cardiac death in a first-degree relative younger than 60 years.

An alternative approach might be to select patients with a Framingham risk score consistent with at least a moderate risk of serious cardiac events within 5 years. Attempts to extend screening to persons with lower degrees of risk are not recommended because screening is extremely unlikely to improve patient outcome.


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