Angina puts men at greater risk of heart attack and death than women, says new research from the UK that suggests men with angina have twice the risk of having a heart attack and are three times more likely to die of heart disease or an illness linked to it than women with angina.

The study was conducted by researchers in Scotland and Ireland led by Dr Brian Buckley of National University Ireland (NUI), Galway, and is published online on 6 August in BMJ.

Angina is a common condition in the UK, affecting some 4.8 per cent of men and 3.4 per cent of women in England and 6.6 per cent of men and 5.6 per cent of women in Scotland. Angina is often the first sign of ischaemic heart disease.

Buckley, who is Cochrane Fellow and researcher in Primary Care at NUI Galway and an Honorary Research Fellow at the University of Aberdeen explained angina must be taken seriously and this study shows how important it is for people with the condition to keep taking their medication and also change their lifestyle:

"This message is so important and is today reinforced by the fact that the British Medical Journal - one of the top medical journals in the world - published this research."

The study is the first to look at records of deaths in relation to information on primary and secondary care to assess the risks of angina in men and women, according to a media release from NUI.

For the research Buckley and colleagues identified 1,785 men and women of average age 62 who were newly diagnosed with angina at 40 primary care practices in Scotland from January 1998 to December 2001.

The researchers also noted any other underlying conditions that the participants had, such as diabetes, high blood pressure, and whether they smoked, were obese and had any other cardiovascular risk factors. They estimated deprivation status from each patient's postcode.

Buckley and colleagues then followed the participants for five years.

They found that older, obese male smokers were the participants most likely to have a heart attack, while any of these factors was linked with an increased risk of death from heart disease or other causes.

The likelihood of undergoing angioplasty (PTCA, to open blocked arteries) or having a coronary artery bypass (CABG), was also higher in men than in women. But, curiously, neither of these procedures appeared to prolong survival by very much.

Buckley and colleagues concluded that:

"In this sample of people with incident angina from primary care, there were sex differences in survival and age and sex differences in the provision of revascularisation after a diagnosis."

"Acute myocardial infarction [heart attack] after a diagnosis of angina was strongly predictive of mortality," they added, and recommended that:

"To minimise adverse outcomes, optimal preventive treatments should be used in patients with angina."

Buckley also said that because of the way the clinical datasets were made anonymous, it was not possible at any time for the researchers to identify individual patients whose records fed into the analysis.

"This study illustrates the great value of using such anonymous clinical datasets to answer important research questions, in a rigorous way which protects patient confidentiality," he added.

"Five year prognosis in patients with angina identified in primary care: incident cohort study."
Brian S Buckley, Colin R Simpson, David J McLernon, Andrew W Murphy, Philip C Hannaford.
BMJ 2009;339:b3058
Published online 6 August 2009.
doi:10.1136/bmj.b3058

Sources: National University of Ireland.

: Catharine Paddock, PhD