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Rose angina predicts 23-year coronary heart disease mortality in women and men aged 40–49 years

¹ Norwegian Institute of Public Health, Nydalen, Oslo, Norway
² Institute of Community Medicine, University of Tromsø, Tromsø, Norway
³ Department of Cardiology, University Hospital of North Norway, Tromsø, Norway

Correspondence to:
Dr S Graff-Iversen, Norwegian Institute of Public Health, Marcus Thranesgate 6, Box 4404 Nydalen, NO-0403 Oslo; sgri{at}fhi.no

ABSTRACT
Objective: To determine the long-term coronary heart disease (CHD) mortality in women and men with symptoms, according to the Rose Angina Questionnaire at a relatively young age.

Design: Cohort study with the baseline survey conducted during 1974–8. Information on symptoms was collected by a short, three-item version of the Rose Angina Questionnaire. Participants were re-invited to a similar survey five years later and followed for mortality throughout 2000.

Setting: Three counties in Norway (the Norwegian Counties Study).

Participants: 16 616 men and 16 265 women aged 40–49 years and denying CHD in 1974–8.

Main outcome measure: CHD mortality during 23 years.

Results: By the end of follow-up 1316 men (7.9%) and 310 women (1.9%) had died from CHD, including 16% (66/406) of men and 4% (24/563) of women with Rose angina in 1974–8. Rose angina implied an elevated mortality from CHD with adjusted hazard ratios 1.50 (95% CI 1.16 to 1.93) in men and 1.98 (95% CI 1.30 to 3.02) in women. According to calculations based on the Cox model these increases in risk are similar to those associated with elevations of total cholesterol by 1.8 mmol/l (men) and 2.5 mmol/l (women) or elevations of systolic blood pressure by 21 mm Hg (men) or 31 mm Hg (women).

Conclusions: Angina symptoms in ages as low as 40–49 years were associated with elevated long-term CHD mortality in Norwegian women and men. This indicates that the three-item version of the Rose Angina Questionnaire, although a screening tool rather than a diagnostic test, adds information on undiagnosed CHD in both sexes.