Three-Question Quiz Predicts CHD Death

In a long-term follow-up study, angina symptoms in men and women in their 40s as reported on a short version of the World Health Organization’s Rose Angina Questionnaire were a major risk factor for premature death due to coronary heart disease (CHD).

This finding supports results of a previous study indicating that "Rose angina is not a benign finding and warrants investigation in both sexes," notes the study team in the April issue of the journal Heart.

Dr. S. Graff-Iversen from the Norwegian Institute of Public Health in Oslo and colleagues explain that the shortened Rose Angina Questionnaire asked three 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 pace? If you stop or slow down, does the pain disappear after less than 10 minutes, or after 10 minutes or more?

Criteria for Rose 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 the authors, 16,616 men and 16,265 women ages 40 to 49 years without CHD completed the shortened 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%) and 310 women (1.9%) had died from CHD, including 16% of men and 4% of women with Rose angina in 1974-1978. The adjusted hazard ratio for CHD death with Rose angina was 1.50 in men and 1.98 in women.

The clinicians note that the relative excess risk conferred by Rose angina is similar to that associated with elevations in total cholesterol of 1.8 mmol/L in men and 2.5 mmol/L in women or elevations in systolic blood pressure of 21 mm mercury in men and 31 mm mercury in women.

"The three-item version of the Rose Angina Questionnaire, although a screening tool rather than a diagnostic test, adds information on undiagnosed CHD in both sexes," Dr. Graff-Iversen and colleagues conclude.

Heart 2008;94:482-486.

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