Men with angina are twice as likely to have a heart attack and almost three times as likely to suffer a heart disease-related death than women with the same condition, finds a study published on bmj.com today (August 7).
The study is the first to link primary and secondary care data with mortality records to assess the risks of angina among men and women.
In the United Kingdom, angina is common and is often the first manifestation of ischaemic heart disease. Recent estimates suggest that 4.8% of men and 3.4% of women aged over 16 in England have the condition, while in Scotland angina is reported to occur in 6.6% of men and 5.6% of women. It is therefore important for both patients and their clinicians to understand the risks following a diagnosis of angina.
Led by Dr Brian Buckley of the National University of Ireland, Galway, researchers based in Scotland and Ireland identified 1,785 patients (average age 62 years) from 40 primary care practices in Scotland who were newly diagnosed with angina between January 1998 and December 2001.
Underlying conditions, such as diabetes and high blood pressure, were recorded and cardiovascular risk factors, such as smoking and obesity, were also assessed. The postcode of each patient was also used to assign a deprivation status.
Participants were tracked for five years. Being male, older and a smoker was associated with an increased risk of having a heart attack, while being male, older, obese and a smoker were each associated with an increased risk of death from heart disease or any cause.
The likelihood of having a procedure to open up blocked arteries, known as angioplasty (PTCA) or coronary artery bypass surgery (CABG), was also higher in men than in women. But, interestingly, neither procedure was associated with significantly improved survival.
This study has shown that a number of characteristics, including male sex, age, smoking and obesity, in people with a first diagnosis of angina are strongly associated with subsequent risk of a number of cardiac outcomes, say the authors.
These results suggest that appropriate control of risk factors and optimal use of preventative medical treatments should be aggressively pursued in patients with angina, they conclude.
Dr Buckiey, Cochrane Research Fellow, Department of General Practice, National University of Ireland, Galway, said: "Angina must be taken seriously. This research really shows how important it is for people with angina to change their lifestyle and take their tablets. The fact that the British Medical Journal – one of the top medical journals in the world – published this research emphasizes how important the message is."
Professor Phil Hannaford, NHS Grampian Chair of Primary care and Head of Division of Applied Health Sciences, University of Aberdeen, added: "At a time when many people are naturally concerned about data protection, this study illustrates the great value of using clinical datasets to answer important research questions, in a rigorous way which protects patient confidentiality."
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