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Persistent angina: highly prevalent and associated with long-term anxiety, depression, low physical functioning, and quality of life in stable angina pectoris

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Abstract

Aims

To evaluate persistent angina in stable angina pectoris with no obstructive coronary artery disease (CAD) compared to obstructive CAD and its relation to long-term anxiety, depression, quality of life (QOL), and physical functioning.

Methods and results

We invited 357 patients (men = 191; women = 166; response rate 83 %) with no prior cardiovascular disease who had a first-time coronary angiography (CAG) in 2008–2009 due to suspected stable angina to participate in a questionnaire survey in 2011 with the Seattle Angina Questionnaire and the Hospital Anxiety and Depression Scale as key elements. Long-term persistent angina (i.e., symptoms at least once a month) was present in 64 % of patients with diffuse non-obstructive CAD (1–49 % stenosis), 49 % of patients with normal coronary arteries (0 % stenosis), and 41 % of patients with obstructive CAD (≥50 % stenosis) (P = 0.01). Depression and anxiety were more common in patients with persistent angina: 24 versus 7 % (P < 0.001) reported HADS-Depression-scores >7 and 42 versus 21 % (P < 0.001) reported HADS-Anxiety-scores >7. In multivariate regression models, persistent angina was associated with depression (OR 4.3, 95 % confidence interval (CI) 1.9–9.6, P < 0.001), anxiety (OR 2.9, 95 % CI 1.6–5.1, P < 0.001), the severity of persistent angina with impaired physical functioning (P < 0.001), and QOL (P < 0.001); whereas outcomes were not related to age, gender, or degree of CAD.

Conclusions

The study indicates higher prevalence of persistent angina in patients with diffuse non-obstructive CAD or normal coronary arteries than in patients with obstructive CAD. Persistent angina symptoms were associated with long-term anxiety, depression, impaired physical functioning, and QOL irrespective of the degree of CAD. Contrary to common perception, excluding obstructive CAD in stable angina does not ensure a favorable disease course, and further risk stratification and treatment strategies are warranted.

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Acknowledgments

This work was supported by The Danish Heart Foundation (11-04-R83-A3257-22621).

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark

    Lasse Jespersen, Steen Z. Abildstrøm & Eva Prescott

  2. National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 1399, Copenhagen, Denmark

    Anders Hvelplund

  3. Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65, 2900, Hellerup, Denmark

    Anders Hvelplund

Authors
  1. Lasse Jespersen
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  2. Steen Z. Abildstrøm
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  3. Anders Hvelplund
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  4. Eva Prescott
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Correspondence to Lasse Jespersen.

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Jespersen, L., Abildstrøm, S.Z., Hvelplund, A. et al. Persistent angina: highly prevalent and associated with long-term anxiety, depression, low physical functioning, and quality of life in stable angina pectoris. Clin Res Cardiol 102, 571–581 (2013). https://doi.org/10.1007/s00392-013-0568-z

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  • DOI: https://doi.org/10.1007/s00392-013-0568-z

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