Risk factors for non-cardiac chest pain in the community.
BACKGROUND
Non-cardiac chest pain is a common and expensive condition. Risk factors for non-cardiac chest pain are poorly understood and lack description in the USA community.


OBJECTIVE
To explore risk factors and health-seeking behaviour in non-cardiac chest pain in a USA community.


METHODS
Olmsted County, MN subjects who reported at least monthly or severe chest pain in response to a validated questionnaire were compared with controls. All the Mayo Clinic medical records were reviewed; those with cardiac disease or relevant organic conditions were excluded.


RESULTS
Of 2118 eligible subjects, 1524 (72%) returned a questionnaire, 389 subjects (26%) reported any chest pain and 186 (12.2%) at least monthly or severe chest pain. Of these, 62 were excluded for a cardiac diagnosis or another organic cause. Thus, 124 subjects (9.1%, 95% CI: 7.6-10.8%) reported at least monthly or severe non-cardiac chest pain, of which 65 (52.4%) had frequent reflux symptoms. Independent risk factors for non-cardiac chest pain were obesity (OR 3.0, 95% CI: 1.64-5.50), family history of reflux (OR 2.8, 95% CI: 1.73-4.32), previous cigarette use (OR 2.0, 95% CI: 1.27-3.18), aspirin use (OR 1.5, 95% CI: 1.00-2.31) and use of antiarthritis medicines (OR 2.0, 95% CI: 1.27-3.16). Compared with subjects with non-cardiac chest pain and associated gastro-oesophageal reflux symptoms, subjects with non-cardiac chest pain without associated gastro-oesophageal reflux symptoms were less likely to have a family history of reflux, more likely to be younger, and less likely to be obese. Compared with controls, subjects with non-cardiac chest pain without gastro-oesophageal reflux symptoms were younger (OR 0.97, 95% CI: 0.95-0.99), reported higher somatic symptom scores (OR 1.1, 95% CI: 1.08-1.73) and were more likely to be obese (OR 2.6, 95% CI: 1.15-5.93).


CONCLUSIONS
Recurrent or severe non-cardiac chest pain is common in the community. Half of the people with significant non-cardiac chest pain have frequent reflux symptoms, thus, risk factors for non-cardiac chest pain are similar to risk factors for gastro-oesophageal reflux disease. People with non-cardiac chest pain without reflux symptoms have a slightly different risk factor profile.
Wise
J L
JL
Mayo Clinic College of Medicine, Rochester, MN 55905, USA. wise.james@mayo.edu
Locke
G R
GR
Zinsmeister
A R
AR
Talley
N J
NJ
D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D015438:Health Behavior; D006801:Humans; D016015:Logistic Models; D008281:Maine / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D011795:Surveys and Questionnaires