Chest pain in middle-age an ominous sign, study hints

NEW YORK (Reuters Health) - In a long-term follow-up study, chest pain felt by men and women in their 40s was a major risk factor for premature death due to heart disease later on.

In the study, chest pain or "angina" was determined by answers to a shortened version of the widely used World Health Organization's Rose Angina Questionnaire, which asks three simple questions: Do you get pain or discomfort in your chest when walking up hills, stairs or hurrying on level ground? If you get pain or discomfort in the chest when walking, do you usually stop, slow down, or carry on at the same place? If you stop or slow down, does the pain disappear after less than 10 minutes, or after 10 minutes or more?

Criteria for angina were answers of "yes" to the first question, "stop" or "slow down" to the second question, and "less than 10 minutes" to the third question.

According to Dr. S. Graff-Iversen from the Norwegian Institute of Public Health in Oslo and colleagues, 16,616 men and 16,265 women ages 40 to 49 years free of heart disease completed the questionnaire between 1974 and 1978. Five years later, between 1977 and 1983, 15,318 men and 15,301 women completed it again.

By the year 2000, 1,316 men (7.9 percent) and 310 women (1.9 percent) had died from heart disease, including 16 percent of men and 4 percent of women with angina in 1974-1978.

The risk of death from heart disease was much higher in men and women with angina than in those without, the investigators report in the medical journal Heart.

The relative excess risk conferred by angina is similar to that associated with modest elevations in cholesterol and blood pressure, they note.

This study, the investigators say, supports results of a previous study indicating that "Rose angina" is not a benign finding and warrants investigation in both sexes.

SOURCE: Heart, March 2008.