Favourable long-term prognosis in stable angina pectoris: an extended follow-up of the Angina Prognosis study In Stockholm (APSIS)

Paul Hjemdahl ^1*, Sven V Eriksson ², Claes Held ³, Lennart Forslund ⁴, Per Näsman ⁵ and Nina Rehnqvist ⁶

¹ Dept of Medicine, Clin Pharm Unit, Karolinska University Hospital (Solna), Sweden
² Dept of Internal Medicine, Karolinska Institutet at Danderyd Hospital, Sweden
³ Dept of Medicine, Cardiology Unit, Karolinska University Hospital (Solna), Sweden
⁴ Medical Products Agency, Uppsala, Sweden
⁵ Royal Institute of Technology, SE-10044 Stockholm, Sweden
⁶ Swedish Council on Technology Assessment in Health Care, Stockholm, Sweden

^* To whom correspondence should be addressed. E-mail: paul.hjemdahl{at}medks.ki.se.

Accepted 4 May 2005

Abstract

Objective: To evaluate the long term prognosis of patients with stable angina pectoris.

Design: Registry based follow-up (median 9.1 years) of patients participating in the Angina Prognosis Study in Stockholm (APSIS), which was a double-blind, single centre trial of antianginal drug treatment.

Patients: 809 patients (31% women) with stable angina pectoris <70 (59±7 years at inclusion), and an age- and sex-matched reference population from the same catchment area.

Interventions: Double-blind treatment with metoprolol or verapamil during 3.4 years (median), followed by referral for usual care with open treatment.

Main outcome measures: CV death and non-fatal myocardial infarction (MI) in the APSIS cohort, and total mortality in comparisons with reference subjects.

Results: 123 patients died (41 MI, 36 other CV causes), and 72 suffered non-fatal MI. Mortality (19% vs. 6%; p<0.001) and fatal MI (6.6 vs. 1.6%; p<0.001) were increased among male compared to female patients. Diabetes, previous MI, hypertension, and male sex independently predicted CV mortality (p<0.001). Diabetes markedly increased the risk in a small subgruoup of female patients. Male patients hade higher mortality rates than males in the reference population during the first three years (cumulative absolute difference 3.8%), but apparently not thereafter. Female patients had similar mortality rates as females in the reference population throughout the 9.1 years of observation.

Conclusions: Female patients with stable angina had similar mortality rates as matched female reference subjects, but male patients had an increased risk. Diabetes, previous MI, hypertension and male sex were strong risk factors for CV death or MI.

Keywords: death, diabetes mellitus, gender, myocardial infarction, stable angina pectoris

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