Angina Pectoris in a Contemporary Population: Characteristics and Therapeutic Implications

Abstract

We characterized a contemporary, nonhospitalized population with angina pectoris by obtaining data from a geographically diverse cohort of 5125 outpatients with chronic stable angina cared for by 1266 primary-care physicians. Diagnosis was based on history supported by evidence for coronary artery disease (coronary angiography, old myocardial infarction [MI], and/or an abnormal stress test). Their mean age was 69 years and 53% were women. Seventy percent had more than one associated illness, and 65% used more than one cardiovascular drug. Calcium antagonists (46%) and nitrates (61%) were used most frequently. Median angina frequency was approximately 2 episodes/week, and increased angina frequency was associated (P < 0.0001) with decreased overall feeling of well-being. Although effort angina was present in 90% of patients, 47% also had rest angina and 34% had mental stress–evoked angina. Female gender (odds ratio: 1.09; 95% CI: 1.02–1.16), concomitant illness (1.17, 1.09–1.25), and pharmacotherapy (1.14, 1.07–1.22) were associated with rest angina. Younger age (1.30, 1.20–1.41), female gender (1.16, 1.07–1.26), concomitant illness (1.13, 1.03–1.24), and pharmacotherapy (1.28, 1.15–1.93) were associated with mental stress angina. Calcium antagonists were used for rest-evoked (1.09, 1.03–1.16) and mental stress–evoked (1.12, 1.04–1.21) angina. These data suggest that contemporary outpatients with angina are most likely to be women and elderly patients with high frequencies of associated illness, calcium antagonist and nitrate use, as well as rest- and mental stress–related angina. These characteristics differ from previous perceptions.