title: Prognosis of angina with and without a diagnosis: 11 year follow up in the Whitehall II prospective cohort study.
abstract: OBJECTIVE
  To investigate the prognosis of angina among people with and without diagnosis by a doctor and an abnormal cardiovascular test result.
  
  
  METHODS
  Prospective cohort study with a median follow up of 11 years.
  
  
  METHODS
  20 civil service departments originally located in London.
  
  
  METHODS
  10 308 civil servants aged 35-55 years at baseline.
  
  
  METHODS
  Recurrent reports of angina; quality of life (SF-36 physical functioning); non-fatal myocardial infarction; death from any cause (n = 344).
  
  
  RESULTS
  1158 (11.4%) participants developed angina, and 813 (70%) had no evidence of diagnosis by a doctor at the time of the initial report. Participants without a diagnosis had an increased risk of impaired physical functioning (age and sex adjusted odds ratio of 2.36 (95% confidence interval 1.91 to 2.90)) compared with those who had neither angina nor myocardial infarction throughout follow up. Among reported cases of angina without a diagnosis, the 15.5% with an abnormality on a study electrocardiogram had an increased risk of death (hazard ratio 2.37 (1.16 to 4.87)). These effects were similar in magnitude to those in participants with a diagnosis of angina.
  
  
  CONCLUSIONS
  Undiagnosed angina was common and had an adverse impact on prognosis comparable to that of diagnosed angina, particularly among people with electrocardiographic abnormalities. Efforts to improve prognosis among people with angina should take account of this submerged clinical iceberg.
authors.affiliation: International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, London WC1E 6BT. h.hemingway@public-health.ucl.ac.uk
authors.forename: Harry
authors.initials: H
authors.lastname: Hemingway
authors.forename: Martin
authors.initials: M
authors.lastname: Shipley
authors.forename: Annie
authors.initials: A
authors.lastname: Britton
authors.forename: Michael
authors.initials: M
authors.lastname: Page
authors.forename: Peter
authors.initials: P
authors.lastname: Macfarlane
authors.forename: Michael
authors.initials: M
authors.lastname: Marmot
mesh_terms: D000328:Adult; D000787:Angina Pectoris / Q000175:diagnosis / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis