Key result
Among middle-aged individuals, angina pectoris symptoms were associated with a higher prevalence of obstructive coronary atherosclerosis compared to those without angina (11.8% vs 5.4%, p<0.001).
Why the study?
The study was conducted to evaluate the contemporary prevalence and correlates of angina pectoris symptoms, and their relationship with coronary atherosclerosis in a middle-aged general population.
Cross-Sectional (n=28,974)
Angina symptoms in a middle-aged general population are common but have a low association with obstructive coronary atherosclerosis, being strongly driven by sociodemographic and psychological factors.
Answers are grounded in this paper and cite their sources.
Angina symptom assessment in middle-aged adults may guide evaluation; observational data leaves open links to atherosclerosis burden.
OBJECTIVE: To assess the contemporary prevalence of, and factors associated with angina pectoris symptoms, and to examine the relationship to coronary atherosclerosis in a middle-aged, general population. METHODS: Data were based on the Swedish CArdioPulmonary bioImage Study (SCAPIS), in which 30 154 individuals were randomly recruited from the general population between 2013 and 2018. Participants that completed the Rose Angina Questionnaire were included and categorised as angina or no angina. Subjects with a valid coronary CT angiography (CCTA) were categorised by degree of coronary atherosclerosis; ≥50% obstruction (obstructive coronary atherosclerosis), <50% obstruction or any atheromatosis (non-obstructive coronary atherosclerosis) or none (no coronary atherosclerosis). RESULTS: The study population consisted of 28 974 questionnaire responders (median age 57.4 years, female 51.6%, hypertension 19.9%, hyperlipidaemia 7.9%, diabetes mellitus 3.7%), of which 1025 (3.5%) fulfilled the criteria of angina. Coronary atherosclerosis was more common in individuals having angina compared with those with no angina (n=24 602, obstructive coronary atherosclerosis 11.8% vs 5.4%, non-obstructive coronary atherosclerosis 38.9% vs 37.0%, no coronary atherosclerosis 49.4% vs 57.7%, all p<0.001). Factors independently associated with angina were birthplace outside of Sweden (OR 2.58 (95% CI 2.10 to 2.92)), low educational level (OR 1.41 (1.10 to 1.79)), unemployment (OR 1.51 (1.27 to 1.81)), poor economic status (OR 1.85 (1.38 to 2.47)), symptoms of depression (OR 1.63 (1.38 to 1.92)) and high degree of stress (OR 2.92 (1.80 to 4.73)). CONCLUSION: Angina pectoris symptoms are common (3.5%) among middle-aged individuals of the general population of Sweden, though with low association to obstructive coronary atherosclerosis. Sociodemographic and psychological factors are highly associated with angina symptoms, irrespective of degree of coronary atherosclerosis.
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Welén-Schef et al. (2023) conducted a cross-sectional in Angina pectoris (n=28,974). Angina pectoris symptoms vs. No angina was evaluated on Obstructive coronary atherosclerosis (≥50% obstruction) (p=<0.001). Among middle-aged individuals, angina pectoris symptoms were associated with a higher prevalence of obstructive coronary atherosclerosis compared to those without angina (11.8% vs 5.4%, p<0.001).
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