title: Anginal symptoms consistently predict total mortality among outpatients with coronary artery disease.
abstract: BACKGROUND
  Age, race, education, and diabetes have been associated with differences in anginal symptoms, treatments, and outcomes among outpatients with coronary artery disease (CAD), but there is little data on whether such characteristics affect relationships between anginal symptoms and mortality.
  
  
  METHODS
  Using a prospective cohort design, we examined associations of anginal symptoms, as assessed by the Seattle Angina Questionnaire, with total mortality among 8908 outpatients with CAD to investigate whether this relationship is influenced by patient demographic or clinical characteristics. Potential effect modification was primarily assessed for age, race, education, and diabetes, and secondarily assessed for smoking, prevalent congestive heart failure (CHF), myocardial infarction, and coronary revascularization.
  
  
  RESULTS
  Over 2 years mean follow-up, there were 896 deaths. After adjustment for potential confounders, persons reporting greater physical limitation due to angina had higher mortality: 27% higher with mild limitation (hazard ratio [HR] 1.27, 95% CI 0.98-1.64), 61% higher with moderate limitation (HR 1.61, 95% CI 1.27-2.05), and 2.5-fold higher with the greatest limitation (HR 2.55, 95% CI 1.97-3.30), compared with little or no limitation (P for trend <.001). Anginal instability was also independently predictive of mortality. There was little evidence that these relationships varied by age, race, education, diabetes, smoking, or presence of CHF, prior myocardial infarction, or prior coronary revascularization (P for each interaction >.28). Anginal symptoms predicted higher mortality risk comparable to a decade of age difference, presence of diabetes, or presence of CHF.
  
  
  CONCLUSIONS
  Among outpatients with CAD, self-reported anginal symptoms consistently predict mortality irrespective of differences in age, race, education, or clinical comorbidities.
authors.affiliation: Health Services Research & Development Center of Excellence, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Wash, USA. darymd@hotmail.com
authors.forename: Dariush
authors.initials: D
authors.lastname: Mozaffarian
authors.forename: Chris L
authors.initials: CL
authors.lastname: Bryson
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Mary B
authors.initials: MB
authors.lastname: McDonell
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Fihn
mesh_terms: D000367:Age Factors; D000368:Aged; D000787:Angina Pectoris / Q000150:complications* / Q000208:ethnology / Q000401:mortality; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D003324:Coronary Artery Disease / Q000208:ethnology / Q000401:mortality*; D004522:Educational Status; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013223:Statistics as Topic