Variability of angina symptoms and the risk of major ischemic heart disease events

Variability of angina symptoms over a Ei-year period was examined in a pros pective study, in which 7,109 British middle-aged men completed two chest p ain questionnaires, Q1 (1978-1980) and Q5 (1983-1985), and were classified as having no chest pain, nonexertional chest pain, or angina (Q) (exertiona l chest pain) on each occasion. Within persons, there was considerable vari ability in response to the chest pain questions at Q1 and Q5. Angina (Q) pe rsistence showed marked associations with previous myocardial infarction, d iagnosed angina, electrocardiogram ischemia, and subsequent major ischemic heart disease events from Q5 onward. Compared with men without angina (Q), the age-adjusted hazard ratios were 1.5 (95% confidence interval (CI): 1.1, 2.2) for angina (Q) at Q1 only, 2.6 (95% CI: 2.1, 3.2) for angina (Q) at Q 5 only, and 3.4 (95% CI: 2.8, 4.3) for angina (Q) on both occasions. For me n without diagnosed ischemic heart disease, for whom apparent remission of angina IQ) was particularly frequent, a similar pattern of association was found between angina (Q) persistence and subsequent major events, In middle -aged men, exertional chest pain is a strong indicator of major coronary ri sk but frequently appears transient in the longer term. Persistently report ed symptoms are associated with severe disease and a poor prognosis.