A population study of the long-term consequences of Rose angina: 20 year follow-up of the Renfrew-Paisley study

Niamh F Murphy ¹, Simon Stewart ², Carole L Hart ³, Kate P MacIntyre ³, David Hole ³ and John JV McMurray ^3*

¹ Western Infirmary, Glasgow, United Kingdom
² University of South Australia, Australia
³ University of Glasgow, United Kingdom

^* To whom correspondence should be addressed. E-mail: j.mcmurray{at}bio.gla.ac.uk.

Accepted 14 June 2006

Abstract

Objective: To examine the long-term cardiovascular consequences of angina in a large epidemiological study. Design: Prospective cohort study conducted between 1972 and 1976 with 20 years of follow-up (the Renfrew-Paisley Study).

Setting: Renfrew and Paisley in the West of Scotland.

Participants: 7048 men and 8354 women aged 45-64 years who underwent comprehensive cardiovascular screening at baseline including Rose angina questionnaire and electrocardiogram.

Main outcome measures: All deaths and hospitalisations for cardiovascular reasons occurring over the subsequent 20 years according to baseline Rose angina score and baseline electrocardiogram.

Results: At baseline 669 (9.5%) men and 799 (9.6%) women had angina on Rose angina questionnaire. All-cause mortality for those with Rose angina was 67.7% in men and 43.3% in women at 20 years compared to 45.4% and 30.4% in those without angina (p<0.001). In a multivariable analysis, men with Rose angina had an increased risk of cardiovascular death or hospitalization (HR1.49 95%CI 1.33-1.66), myocardial infarction (1.63 (1.41-1.85)) and heart failure (1.54 (1.13-2.10)) relative to men without angina. The corresponding hazard ratios for women were 1.38(1.23-1.55), 1.56(1.31-1.85) and 1.92(1.44-2.56). An abnormal ECG increased risk further and both angina and an abnormal ECG most of all compared to those with neither angina nor an ischaemic ECG. Compared to men, women with Rose angina were less likely to have a cardiovascular event (HR 0.54 (0.46-0.64)), or myocardial infarction (0.44 (0.35-0.56)), though there was no gender difference in the risk of stroke (1.11 (0.75-1.65)), atrial fibrillation (0.84 (0.38-1.87)) or heart failure (0.79 (0.51-1.21)).

Conclusions: Angina in middle-age substantially increases the risk of death, myocardial infarction, heart failure and other cardiovascular events.

Keywords: angina, epidemiology, morbidity, mortality, prognosis

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