Role of Exercise Stress Testing in Asymptomatic Patients with Coronary Risk Factors in a Tertiary Care Hospital

Abstract

Background: Cardiovascular Diseases (CVDs) are a major global health burden, with Ischemic Heart Disease (IHD) being the most prevalent form. The Treadmill Test (TMT) is a widely used non-invasive tool for detecting exercise-induced ischemia and assessing cardiovascular risk. This study evaluated the risk factors, symptoms and demographic distribution of positive TMT results. Objectives: (1) To estimate the risk factors associated with a positive TMT. (2) To assess the age and sex distribution of positive TMT cases. Methods: A hospital-based cross-sectional study was conducted over 18 months at Rajarajeshwari Medical College and Hospital, Bengaluru and included 100 adults aged 18-70 years at increased risk of IHD. Demographic variables, medical history and laboratory investigations were recorded and all participants underwent TMT to assess ischemia. Data were analyzed using SPSS version 23 and the Chi-square test. Results: Most participants were aged 51-60 years (32%), followed by 41-50 years (30%) and 65% were male. The prevalence of risk factors was: diabetes 98%, hypertension 94%, sedentary lifestyle 77%, smoking 74%, obesity 67%, dyslipidemia 65% and family history of cardiovascular disease 19%. The TMT was positive in 38% of participants (95% CI 29.1-47.8). Obesity was the only factor significantly associated with a positive TMT (46.3% Vs 21.2%; P = 0.015; crude odds ratio 3.2, 95% CI 1.2-8.4). Age, sex, diabetes, hypertension, smoking, sedentary lifestyle, family history and symptom category were not significantly associated with the result (all p>0.05).  Conclusion: More than one-third of adults with coronary risk factors had a positive TMT and obesity was a significant factor significantly associated with a positive result. Comprehensive risk-factor management, particularly weight reduction and further evaluation of high-risk individuals with obesity or exertional symptoms are warranted. The study also emphasizes the need for early screening, lifestyle interventions and targeted management for reducing the burden of IHD. TMT remains a valuable, cost effective non invasive tool for risk stratification and prognosis, however Larger multicenter studies with angiographic correlation are needed.