Cardiovascular disease (CVD) is made up of multiple diseases, including coronary heart disease (CHD), hypertension, heart failure, stroke, and congenital cardiovascular disease. Although CVD mortality in the United States has decreased significantly in recent years, the prevalence of CHD has not declined appreciably in the past 2 to 3 decades. This circumstance suggests the benefits of more advanced medical treatment but slower progress in primary disease prevention. The increase in obesity in the United States together with the negative influence of obesity on other coronary artery disease (CAD) risk factors (hypertension, dyslipidemia, and impaired fasting glucose) work against [Page 440]further reduction in CAD prevalence in the near future. Thus, the need for diagnostic testing for myocardial ischemia will continue.

Although there have been many advances in ...