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

Variability of angina symptoms over a 5-year period was examined in a prospective study, in which 7,109 British middle-aged men completed two chest pain questionnaires, Q1 (1978-1980) and Q5 (1983-1985), and were classified as having no chest pain, nonexertional chest pain, or angina (Q) (exertional chest pain) on each occasion. Within persons, there was considerable variability in response to the chest pain questions at Q1 and Q5. Angina (Q) persistence showed marked associations with previous myocardial infarction, diagnosed 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 Q5 only, and 3.4 (95% CI: 2.8, 4.3) for angina (Q) on both occasions. For men without diagnosed ischemic heart disease, for whom apparent remission of angina (Q) 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 risk but frequently appears transient in the longer term. Persistently reported symptoms are associated with severe disease and a poor prognosis

Assessing the impact of medication use on trends in major coronary risk factors in older British men: a cohort study

Aims To investigate the role of medication in 20-year trends in blood pressure (BP) and blood lipids in older British men.Methods and results BP and lipids were measured in 4231 men from a representative cohort at baseline (1978-1980, aged 40-59 years) and after 20 years (1998-2000). Cohort-wide age-adjusted 20-year mean changes were as follows: systolic BP -7.6mmHg (95% confidence interval: -9.7 to -5.4); diastolic BP +3.3mmHg (+2.2 to +4.5); non-high-density lipoprotein (HDL)-cholesterol -0.4 mmol/l (-0.5 to -0.2); HDL-cholesterol +0.16 mmol/l (+0.13 to +0.19). Much (79%) of the systolic BP fall occurred only among 1561 men (37%) reporting the use of BP-lowering medication during the follow-up; systolic BP changed by -12.3mmHg (-14.7 to -9.9) and -1.6mmHg (-3.7 to +0.5) among medication users and men not using medication, respectively (P<0.001 for medication-time interaction). One-third of the non-HDL-cholesterol fall occurred only among 302 men (8%) reporting the use of lipid-regulating drugs; non-HDL-cholesterol changed by -1.8 mmol/l (-2.0 to -1.6) and -0.2 mmol/l (-0.4 to -0.1) among medication users and men not using medication, respectively (P<0.001 for interaction). The HDL-cholesterol increase was not associated with lipid-regulating drug use (P=0.15 for interaction).Conclusion Decreases in BP were largely confined to medication users and overall changes in non-HDL-cholesterol were modest, suggesting the need for greater efforts to reduce BP and cholesterol among the general population. HDL-cholesterol increased among all men, likely reflecting cohort-wide improvements in associated health behaviours. Eur J Cardiovasc Prev Rehabil 17:502-508 (C) 2010 The European Society of Cardiolog