Key result
Female gender is linked to ~9% greater rest angina risk and more mental stress angina.
Why the study?
A contemporary characterization of nonhospitalized outpatients with chronic stable angina was needed to understand their clinical profile and angina patterns.
Cohort (n=5,125)
Yes
Contemporary outpatients with chronic stable angina are frequently elderly women with high rates of comorbidities who experience significant rest and mental stress-related angina alongside effort angina.
Answers are grounded in this paper and cite their sources.
Women with stable angina may face higher risk of rest and mental stress angina; hypothesis-generating and should not yet change practice.
To characterize a contemporary, nonhospitalized population with angina pectoris, data were obtained from a geographically diverse cohort of 5,125 outpatients with chronic stable angina cared for by 1,266 primary care physicians between September and November of 1990. Diagnosis was based on history supported by evidence for coronary artery disease (coronary angiography, old myocardial infarction, or an abnormal stress test, either alone or in combination). The mean age of the patients was 69 years and 53% were women. Seventy percent had > 1 associated illness and 64% took > 1 cardiovascular drug. Median angina frequency was approximately 2 episodes/week and increased angina frequency (p < 0.0001) was associated with decreased overall feeling of well-being. Although effort angina was present in 90% of patients, 47% also had rest angina and 35% had mental stress-evoked angina. Female gender (relative risk [RR] 1.09; 95% confidence interval [CI] 1.02 to 1.16), concomitant illness (RR 1.17; CI 1.09 to 1.25), and pharmacotherapy (RR 1.14; CI 1.07 to 1.22) were associated with excess risk for rest angina. Younger age (RR 1.30; CI 1.20 to 1.41), female gender (RR 1.16; CI 1.07 to 1.26), concomitant illness (RR 1.13; CI 1.03 to 1.24), and pharmacotherapy (RR 1.28; CI 1.15 to 1.93) were associated with excess risk for mental stress angina. These data suggest that contemporary outpatients with angina are frequently women and elderly patients with high rates of associated illness, rest, and mental stress-related angina.
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Pepine et al. (1994) conducted a cohort in chronic stable angina (n=5,125). Female gender vs. Male gender was evaluated on Rest angina (RR 1.09, 95% CI 1.02-1.16). Among outpatients with chronic stable angina, female gender was associated with an increased risk for rest angina (RR 1.09; 95% CI 1.02-1.16) and mental stress angina (RR 1.16; 95% CI 1.07-1.26).
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