On the basis of prognostic considerations, asymptomatic male patients older than 45 years with 1 or more risk factors (hypercholesterolemia, hypertension, smoking, diabetes, or family history of premature CAD) may obtain useful prognostic information from exercise testing. The greater the number of risk factors (ie, pretest probability), the more likely the patient will profit from screening. For these purposes, risk factors should be strictly defined (36): hypercholesterolemia as total cholesterol greater than 240 mg per dL, hypertension as systolic blood pressure greater than 140 mm Hg or diastolic blood pressure greater than 90 mm Hg, smoking, diabetes, and history of heart attack or sudden cardiac death in a first-degree relative less than 60 years old. The importance of more intensive risk factor management in diabetic persons has been increasingly recognized, as reflected in the most recent national guidelines for cholesterol management (ATP III), hypertension (JNC VI), and diabetes control (see http://www.diabetes.org/main/info/link.jsp). In asymptomatic diabetic persons, the likelihood of cardiovascular disease is increased if at least 1 of the following is present: age older than 35 years, type 2 diabetes greater than 10 years’ duration, type 1 diabetes greater than 15 years’ duration, any additional atherosclerotic risk factor for CAD, presence of microvascular disease (proliferative retinopathy or nephropathy, including microalbuminuria), peripheral vascular disease, or autonomic neuropathy. Exercise testing is recommended if an individual meeting the criteria is about to embark on moderate- to high-intensity exercise (37). An alternative approach would be to study patients with a certain level of cardiovascular risk expressed as a continuous variable and therefore accounting for not only the presence but also the severity of risk factors. Such data have been derived in asymptomatic persons from the Framingham study (38). Attempts to extend screening to persons with lower degrees of risk are not recommended because screening is unlikely to improve patient outcome.