Skip to main content
PMC home page
The British Journal of General Practice logoLink to The British Journal of General Practice
. 2003 Oct;53(495):784–789.

Increased mortality among women with Rose angina who have not presented with ischaemic heart disease.

Vicci Owen-Smith 1, Philip C Hannaford 1, Alison M Elliott 1
PMCID: PMC1314711  PMID: 14601354

Abstract

BACKGROUND: Little is known about the clinical importance of disease that is not presented to healthcare services. AIM: To determine the 5-year mortality among those with angina symptoms, known or not known by their general practitioner (GP) to have ischaemic heart disease (IHD). DESIGN: A prospective cohort study. SETTING: The study was conducted in the United Kingdom as part of the Royal College of General Practitioners' Oral Contraception Study. METHOD: In 1994-1995 women (n = 11,797) still under GP observation were sent a questionnaire that inquired about their smoking habits, other lifestyle issues, general health, and selected symptoms (including chest pain, assessed using the Rose angina questionnaire). The main outcome measure was the chances (odds) of dying during the next 5 years, among those with and without exertional chest pain, Rose angina or Rose myocardial infarction (MI), stratified by documented history of IHD. RESULTS: Overall, the lifetime prevalence of any exertional chest pain was 10.1% (95% confidence interval [CI] = 9.5 to 10.8); grade I Rose angina was 6.1% (95% CI = 5.6 to 6.6); grade II Rose angina was 1.3% (95% CI = 1.1 to 1.6); and Rose MI was 4.4% (95% CI = 4.0 to 4.9). The prevalence of each condition tended to increase with age, social class, parity, body mass index, and documented history of IHD. The proportion of women documented as having IHD was 23% among those with any exertional chest pain, 21.7% for grade I Rose angina, 37.7% for grade II Rose angina, and 31.4% for Rose MI. Compared to women without Rose angina, significantly higher odds ratios for all-cause mortality were observed among women with grade I Rose angina and no documented history of IHD (adjusted odds ratio [AOR] = 1.71, 95% CI = 1.05 to 2.79); those with grade II Rose angina and documented IHD (AOR = 3.94, 95% CI = 1.58 to 9.83); and women with grade II Rose angina and no documented history of IHD (AOR = 3.35, 95% CI = 1.47 to 7.62). CONCLUSIONS: Women with angina symptoms that have not been documented by their GP appear to have an increased risk of future mortality. Research is needed to determine the best way of identifying and managing these individuals.

Full Text

The Full Text of this article is available as a PDF (83.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Campbell M. J., Elwood P. C., Abbas S., Waters W. E. Chest pain in women: a study of prevalence and mortality follow up in south Wales. J Epidemiol Community Health. 1984 Mar;38(1):17–20. doi: 10.1136/jech.38.1.17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Coyne J. C., Klinkman M. S., Gallo S. M., Schwenk T. L. Short-term outcomes of detected and undetected depressed primary care patients and depressed psychiatric patients. Gen Hosp Psychiatry. 1997 Sep;19(5):333–343. doi: 10.1016/s0163-8343(97)00055-8. [DOI] [PubMed] [Google Scholar]
  3. Croft P. R., Macfarlane G. J., Papageorgiou A. C., Thomas E., Silman A. J. Outcome of low back pain in general practice: a prospective study. BMJ. 1998 May 2;316(7141):1356–1359. doi: 10.1136/bmj.316.7141.1356. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Davis C. E., Deev A. D., Shestov D. B., Perova N. V., Plavinskaya S. I., Abolafia J. M., Kim H., Tyroler H. A. Correlates of mortality in Russian and US women. The Lipid Research Clinics Program. Am J Epidemiol. 1994 Feb 15;139(4):369–379. doi: 10.1093/oxfordjournals.aje.a117009. [DOI] [PubMed] [Google Scholar]
  5. Frank P. I., Frank T. L., Cropper J., Hirsch S., Niven R. M., Hannaford P., McNamee R. The use of a screening questionnaire to identify children with likely asthma. Br J Gen Pract. 2001 Feb;51(463):117–120. [PMC free article] [PubMed] [Google Scholar]
  6. Frank P., Ferry S., Moorhead T., Hannaford P. Use of a postal questionnaire to estimate the likely under-diagnosis of asthma-like illness in adults. Br J Gen Pract. 1996 May;46(406):295–297. [PMC free article] [PubMed] [Google Scholar]
  7. Hart C. L., Watt G. C., Davey Smith G., Gillis C. R., Hawthorne V. M. Pre-existing ischaemic heart disease and ischaemic heart disease mortality in women compared with men. Int J Epidemiol. 1997 Jun;26(3):508–515. doi: 10.1093/ije/26.3.508. [DOI] [PubMed] [Google Scholar]
  8. Hawthorne V. M., Watt G. C., Hart C. L., Hole D. J., Smith G. D., Gillis C. R. Cardiorespiratory disease in men and women in urban Scotland: baseline characteristics of the Renfrew/Paisley (midspan) study population. Scott Med J. 1995 Aug;40(4):102–107. doi: 10.1177/003693309504000402. [DOI] [PubMed] [Google Scholar]
  9. LaCroix A. Z., Haynes S. G., Savage D. D., Havlik R. J. Rose Questionnaire angina among United States black, white, and Mexican-American women and men. Prevalence and correlates from The Second National and Hispanic Health and Nutrition Examination Surveys. Am J Epidemiol. 1989 Apr;129(4):669–686. doi: 10.1093/oxfordjournals.aje.a115183. [DOI] [PubMed] [Google Scholar]
  10. Lee T. H. Ecology in evolution. N Engl J Med. 2001 Jun 28;344(26):2018–2020. doi: 10.1056/NEJM200106283442610. [DOI] [PubMed] [Google Scholar]
  11. Owen-Smith V., Hannaford P. C., Warskyj M., Ferry S., Kay C. R. Effects of changes in smoking status on risk estimates for myocardial infarction among women recruited for the Royal College of General Practitioners' Oral Contraception Study in the UK. J Epidemiol Community Health. 1998 Jul;52(7):420–424. doi: 10.1136/jech.52.7.420. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. ROSE G. A. The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. Bull World Health Organ. 1962;27:645–658. [PMC free article] [PubMed] [Google Scholar]
  13. Richards H., McConnachie A., Morrison C., Murray K., Watt G. Social and gender variation in the prevalence, presentation and general practitioner provisional diagnosis of chest pain. J Epidemiol Community Health. 2000 Sep;54(9):714–718. doi: 10.1136/jech.54.9.714. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Smith W. C., Kenicer M. B., Tunstall-Pedoe H., Clark E. C., Crombie I. K. Prevalence of coronary heart disease in Scotland: Scottish Heart Health Study. Br Heart J. 1990 Nov;64(5):295–298. doi: 10.1136/hrt.64.5.295. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Wilcosky T., Harris R., Weissfeld L. The prevalence and correlates of Rose Questionnaire angina among women and men in the Lipid Research Clinics Program Prevalence Study population. Am J Epidemiol. 1987 Mar;125(3):400–409. doi: 10.1093/oxfordjournals.aje.a114546. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

RESOURCES