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Prognosis of stable angina pectoris: why we need larger population studies with higher endpoint resolution
  1. Adam D Timmis1,
  2. Gene Feder2,
  3. Harry Hemingway3
  1. 1Cardiac Directorate, Barts and The London NHS Trust, London, UK
  2. 2Centre for Health Sciences, Barts and the London, Queen Mary’s School of Medicine and Dentistry, London, UK
  3. 3Department of Epidemiology and Public Health, University College London Medical School, London, UK
  1. Correspondence to:
    Professor A Timmis
    Department of Cardiology, London Chest Hospital, Bonner Road, London E2 9JX, UK;adamtimmis{at}


The prognosis of angina was described as “"unhappy” by the Framingham investigators and as little different from that of 1-year survivors of acute myocardial infarction. Yet recent clinical trials now report that angina has a good prognosis with adverse outcomes reduced to “normal levels”. These disparate prognostic assessments may not be incompatible, applying as they do to population cohorts (Framingham) and selected participants in clinical trials. Comparisons between studies are further complicated by the absence of agreed case definitions for stable angina (contrast this with acute coronary syndromes). Our recent data show that for patients with recent onset symptoms attending chest pain clinics, angina remains a high-risk diagnosis and although many patients receive symptomatic benefit from revascularisation, prognosis is usually unaffected. This leaves little room for complacency and, with angina the commonest initial manifestation of coronary artery disease, there is the opportunity for early detection, risk stratification and treatment to modify outcomes. Meanwhile, larger population-based studies are needed to define the patient journey from earliest presentation through the various syndrome transitions to coronary or noncardiac death in order to increase understanding of the aetiological and prognostic differences between the different coronary disease phenotypes.

  • CHD, coronary heart disease
  • MI, myocardial infarction

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  • Published Online First 4 September 2006

  • Competing interests: None declared.