Gender-specific prediction of cardiac disease: importance of risk factors and exercise variables.

Current guidelines recommend targeting the intensity of preventive cardiovascular interventions to the level of the patient's risk, which is usually obtained from a global risk score such as the Framingham equations. However, a large proportion of asymptomatic U.S. women (approximately 80-90%) are classified as low risk by the Framingham score, although they have a 1 in 2 chance of dying from cardiovascular disease (CVD) during their lifetime. A promising avenue for improving CVD risk stratification has come from recent studies evaluating the prognostic value of exercise testing in asymptomatic populations using test variables that are not related to exercise-induced ST-segment depression. In particular, it has been shown that 2 easily obtained noninvasive measures, low exercise capacity and slow heart rate recovery, have been linked to increased CVD and all-cause death in both women and men. These 2 simple yet powerful measures of risk that are readily available are useful tools for the practicing cardiologist who desires more accurate assessment of risk in a female patient, particularly if she is deemed as intermediate risk by the Framingham score. In addition, both exercise capacity and heart rate recovery are at least partially modifiable by regular physical activity. Exercise recommendations of at least 30 minutes of moderate physical activity most days of the week have been associated with 30% to 50% reductions in coronary events and coronary mortality and should be recommended to all patients regardless of their Framingham risk score.