Although cardiovascular disease accounts for almost 1 million deaths each year in the United States, one half of these deaths are caused by coronary artery disease (CAD). Approximately one of every three deaths is caused by CAD, the leading cause of death in both genders. Whether considering morbidity or mortality, CAD is the single most important disease entity in the United States and many other industrialized nations. Unfortunately, 1.5 million Americans suffer acute myocardial infarction;s1 each year; however, there are estimates that the risk of myocardial infarction can be lowered as much as 70%.<sup>18Manson J.E., Tosteson H., Satterfield S., e al. The primary prevention of myocardial infarction N Engl J Med 1992 ;  326 : 1406-1416 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Recent interventions successfully have shown not only a CAD regression but also a decrease in its complications,<sup>4Brown B.G., Zhao X.Q., Sacco D.E., e al. Lipid lowering and plaque regression: New insights into prevention of plaque disruption and clinical events in coronary disease Circulation 1993 ;  87 : 1781

Cliccare qui per andare alla sezione Riferimenti</sup> emphasizing the need for early diagnosis. Diagnosis of significant CAD may prevent complications such as myocardial infarctions and may be lifesaving.

Exercise testing is an effective method for diagnosing significant CAD and for evaluating chest pain, especially atypical chest pain. For many of the 13 million Americans with known CAD, exercise testing is an effective method for determining the prognosis and evaluating the management of CAD. Although no perfect test is available to screen the asymptomatic population for CAD, exercise testing is one of the most cost-effective methods and its use may be prudent in patients with significant risk factors, especially men. The use of exercise testing in these populations may facilitate the management of CAD and may prevent some of its burden.

With estimates that the risk of myocardial infarction can be lowered by as much as 70% by nonpharmacologic and nonsurgical means,<sup>18Manson J.E., Tosteson H., Satterfield S., e al. The primary prevention of myocardial infarction N Engl J Med 1992 ;  326 : 1406-1416 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> it is feasible that the overall burden of CAD, including morbidity, mortality, and cost, can be reduced by lifestyle changes alone. One lifestyle change that has the potential for significant impact is the initiation of an exercise program. Only 22% of Americans report light to moderate daily exercise. There are estimates that 250,000 deaths per year in the United States, or about 12% of total deaths, are caused by a lack of physical exercise.;s1 A 50% lower incidence of coronary events has been shown in individuals who maintain a rigorous exercise program 2 days a week.<sup>20Morris C.K., Froelicher V.F. Cardiovascular benefits of improved exercise capacity Sports Med 1993 ;  16 : 225-236 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Often what is needed for a patient to change his or her attitude about exercise is advice from his or her physician.<sup>17Lewis B.S., Lynch W.D. The effect of physician advice on exercise behavior Prev Med 1993 ;  22 : 110-121 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Clinicians who perform exercise testing are able to reassure their patients of the safety of exercise and are able to customize their patients' exercise prescriptions. It is hoped that advice given by clinicians during this process will convince patients of the importance of exercise and will motivate them to initiate and maintain an exercise program.

With the reduction of risk factors now the primary clinical approach to preventing CAD morbidity and mortality,<sup>3Braunwald E.  Heart Disease Philadelphia: WB Saunders (1997). 

Cliccare qui per andare alla sezione Riferimenti</sup> exercise testing should become a priority in clinical practice. As the population ages, the staggering prevalence and burden of CAD is also likely to increase. Fortunately, as the need for exercise testing has increased, equipment costs have decreased, the technology and quality have improved, and the safety of exercise testing has been well documented. With increased availability of training, more clinicians likely will perform and interpret exercise testing, especially in the office. As a technique that has evolved over 70 years, exercise testing remains an effective noninvasive method of diagnosing and managing CAD. Combined with modern CAD interventions, exercise testing is also a useful adjunct for preventing the complications of CAD.