title: Frequency of angina pectoris and secondary events in patients with stable coronary heart disease (from the Heart and Soul Study).
abstract: The extent to which angina pectoris (AP) predicts secondary cardiovascular events beyond independent of measures of disease severity is unknown. We evaluated the association between AP frequency and secondary events in patients with stable coronary heart disease (CHD). We administered the Seattle Angina Questionnaire to 1,023 participants with stable CHD enrolled from September 2000 to December 2002 and followed for a median of 8.9 years. We used Cox proportional hazards to evaluate the association of AP frequency with death and subsequent hospitalization for AP, revascularization, myocardial infarction (MI), or heart failure. At enrollment, 633 (62%) participants reported no AP, 279 (27%) reported monthly AP, and 111 (11%) reported daily or weekly AP. During follow-up, 396 participants died, 204 were hospitalized for AP, 194 for revascularization, 140 for MI, and 188 for heart failure. Compared with participants without AP, participants with daily or weekly AP were more likely to be hospitalized for AP (hazard ratio [HR] 3.3; 95% confidence interval [CI] 2.3 to 4.7; p<0.001), revascularization (HR 2.0; 95% CI 1.3 to 2.9; p=0.001), or heart failure (HR 1.6; 95% CI 1.0 to 2.5; p=0.03) and more likely to die (HR 1.5; 95% CI 1.1 to 2.0; p=0.01). AP was not independently associated with MI (HR 1.3; 95% CI 0.8 to 2.3; p=0.29). After adjusting for demographics, co-morbidities, treadmill exercise capacity, ejection fraction, and inducible ischemia, frequency of AP remained independently associated with hospitalization for AP (HR 2.4; 95% CI 1.6 to 3.6; p<0.001), revascularization (HR 1.7; 95% CI 1.1 to 2.7; p=0.02), and death (HR 1.4; 95% CI 1.0 to 2.0; p=0.045). In conclusion, in outpatients with stable CHD, AP frequency predicts higher rates of secondary cardiovascular events and death, independent of objective measures of disease severity.
authors.affiliation: Department of Medicine, University of California, San Francisco, California. Electronic address: alexis.beatty@gmail.com.
authors.forename: Alexis L
authors.initials: AL
authors.lastname: Beatty
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri, Kansas City, Missouri.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Department of Medicine, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Whooley
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D002140:California / Q000453:epidemiology; D016001:Confidence Intervals; D003327:Coronary Disease / Q000150:complications* / Q000175:diagnosis; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D010045:Outpatients; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
references.citation: Circulation. 2009 Dec 8;120(23):2330-6
references.pmid: 19933930
references.citation: JAMA. 2006 Mar 22;295(12):1404-11
references.pmid: 16551712
references.citation: Circulation. 2009 Jul 14;120(2):126-33
references.pmid: 19564560
references.citation: Circulation. 2003 Nov 18;108(20):2543-9
references.pmid: 14610011
references.citation: J Am Coll Cardiol. 1988 Jan;11(1):20-6
references.pmid: 3335698
references.citation: J Am Coll Cardiol. 1995 Feb;25(2):333-41
references.pmid: 7829785
references.citation: JAMA. 2003 Jul 9;290(2):215-21
references.pmid: 12851276
references.citation: Circulation. 2013 Jun 4;127(22):2233-49
references.pmid: 23648778
references.citation: Am Heart J. 2003 Mar;145(3):493-9
references.pmid: 12660673
references.citation: J Am Soc Echocardiogr. 2007 Sep;20(9):1021-41
references.pmid: 17765820
references.citation: J Gen Intern Med. 2001 Sep;16(9):606-13
references.pmid: 11556941
references.citation: Circulation. 2012 Dec 18;126(25):e354-471
references.pmid: 23166211
references.citation: Am Heart J. 2003 Dec;146(6):1015-22
references.pmid: 14660993
references.citation: J Am Soc Echocardiogr. 1989 Sep-Oct;2(5):358-67
references.pmid: 2698218
references.citation: Circulation. 2002 Jul 2;106(1):43-9
references.pmid: 12093768
references.citation: JAMA. 2008 Nov 26;300(20):2379-88
references.pmid: 19033588