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January 12, 2005

Global Risk Score and Exercise Testing

JAMA. 2005;293(2):159-160. doi:10.1001/jama.293.2.159-a

To the Editor: Dr Aktas and colleagues1 report that impaired functional capacity during exercise stress testing and abnormal heart rate recovery, when combined with the European Systematic Coronary Risk Evaluation (SCORE), may be useful for stratifying mortality risk in asymptomatic patients. A previous study found that resting heart rate before exercise, adjusted for age and sex, was predictive of all-cause mortality in individuals referred for coronary artery disease (hazard ratio [HR], 1.29; P<.001), although the effect was weaker when additionally adjusted for heart rate recovery (HR, 1.14; P = .07).2 Resting heart rate has been found to be associated with cardiovascular mortality and total mortality in other prospective studies.3,4 Given this, it would be interesting to know the impact of the inclusion of resting heart rate as a variable in the Cox proportional hazards model that was developed in the present study.

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