Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2003 Oct 18;327(7420):895.
doi: 10.1136/bmj.327.7420.895.

Prognosis of angina with and without a diagnosis: 11 year follow up in the Whitehall II prospective cohort study

Harry Hemingway  1 , Martin Shipley, Annie Britton, Michael Page, Peter Macfarlane, Michael Marmot
Affiliations

Prognosis of angina with and without a diagnosis: 11 year follow up in the Whitehall II prospective cohort study

Harry Hemingway et al. BMJ. .

Abstract

Objective: To investigate the prognosis of angina among people with and without diagnosis by a doctor and an abnormal cardiovascular test result.

Design: Prospective cohort study with a median follow up of 11 years.

Setting: 20 civil service departments originally located in London.

Participants: 10 308 civil servants aged 35-55 years at baseline.

Main outcome measures: Recurrent reports of angina; quality of life (SF-36 physical functioning); non-fatal myocardial infarction; death from any cause (n = 344).

Results: 1158 (11.4%) participants developed angina, and 813 (70%) had no evidence of diagnosis by a doctor at the time of the initial report. Participants without a diagnosis had an increased risk of impaired physical functioning (age and sex adjusted odds ratio of 2.36 (95% confidence interval 1.91 to 2.90)) compared with those who had neither angina nor myocardial infarction throughout follow up. Among reported cases of angina without a diagnosis, the 15.5% with an abnormality on a study electrocardiogram had an increased risk of death (hazard ratio 2.37 (1.16 to 4.87)). These effects were similar in magnitude to those in participants with a diagnosis of angina.

Conclusion: Undiagnosed angina was common and had an adverse impact on prognosis comparable to that of diagnosed angina, particularly among people with electrocardiographic abnormalities. Efforts to improve prognosis among people with angina should take account of this submerged clinical iceberg.

PubMed Disclaimer

References

    1. McCormick A, Fleming D, Charlton G. Morbidity statistics from general practice: fourth national study 1991-1992. London: HMSO, 1995.
    1. Department of Health. National service framework for coronary heart disease: modern standards and service models. London: Stationery Office, 2000.
    1. Eccles M, Rousseau N, Adams P, Thomas L. Evidence-based guideline for the primary care management of stable angina. Fam Pract 2001;18: 217-22. - PubMed
    1. Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina—summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol 2003;41: 159-68. - PubMed
    1. Lampe FC, Walker M, Lennon LT, Whincup PH, Ebrahim S. Validity of a self-reported history of doctor-diagnosed angina. J Clin Epidemiol 1999;52: 73-81. - PubMed

Publication types