Population	Asymptomatic adults at low risk of CHD events	Asymptomatic adults at intermediate or high risk of CHD events
Recommendation	Do not screen with resting or exercise ECG	No recommendation
	Grade: D	Grade: I (insufficient evidence)
Risk assessment	Several factors are associated with a higher risk of CHD events, including older age, male sex, high blood pressure, smoking, abnormal lipid levels, diabetes mellitus, obesity, and sedentary lifestyle. Calculators are available to ascertain a person's 10-year risk of a CHD event.
	Persons with a 10-year risk greater than 20% are considered to be high risk, those with a 10-year risk less than 10% are considered to be low risk, and those in the 10% to 20% range are considered to be intermediate risk.
Screening tests	Several abnormalities on resting and exercise ECG are associated with an increased risk of a serious CHD event. However, the incremental information offered by screening asymptomatic adults at low risk of a CHD event with resting or exercise ECG (beyond that obtained with conventional CHD risk factors) is highly unlikely to result in changes in risk stratification that would prompt interventions and ultimately reduce CHD-related events.
Balance of benefits and harms	The potential harms of screening for CHD with exercise or resting ECG equal or exceed the potential benefits in this population.	The USPSTF could not determine the balance between the benefits and harms of screening for CHD with resting or exercise ECG in this population.
Other relevant USPSTF recommendations	The USPSTF has made recommendations on screening for carotid artery stenosis, high blood pressure, lipid disorders, peripheral arterial disease, and obesity. These recommendations are available at http://www.uspreventiveservicestaskforce.org/.