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Prevalence of angina pectoris and association with coronary atherosclerosis in a general population

Welén Schef, Kerstin ; Tornvall, Per ; Alfredsson, Joakim ; Hagström, Emil ; Ravn-Fischer, Annica ; Soderberg, Stefan ; Yndigegn, Troels LU and Jernberg, Tomas (2023) In Heart 109(19). p.1450-1459
Abstract

Objective To assess the contemporary prevalence of, and factors associated with angina pectoris symptoms, and to examine the relationship to coronary atherosclerosis in a middle-aged, general population. Methods Data were based on the Swedish CArdioPulmonary bioImage Study (SCAPIS), in which 30 154 individuals were randomly recruited from the general population between 2013 and 2018. Participants that completed the Rose Angina Questionnaire were included and categorised as angina or no angina. Subjects with a valid coronary CT angiography (CCTA) were categorised by degree of coronary atherosclerosis; ≥50% obstruction (obstructive coronary atherosclerosis), <50% obstruction or any atheromatosis (non-obstructive coronary... (More)

Objective To assess the contemporary prevalence of, and factors associated with angina pectoris symptoms, and to examine the relationship to coronary atherosclerosis in a middle-aged, general population. Methods Data were based on the Swedish CArdioPulmonary bioImage Study (SCAPIS), in which 30 154 individuals were randomly recruited from the general population between 2013 and 2018. Participants that completed the Rose Angina Questionnaire were included and categorised as angina or no angina. Subjects with a valid coronary CT angiography (CCTA) were categorised by degree of coronary atherosclerosis; ≥50% obstruction (obstructive coronary atherosclerosis), <50% obstruction or any atheromatosis (non-obstructive coronary atherosclerosis) or none (no coronary atherosclerosis). Results The study population consisted of 28 974 questionnaire responders (median age 57.4 years, female 51.6%, hypertension 19.9%, hyperlipidaemia 7.9%, diabetes mellitus 3.7%), of which 1025 (3.5%) fulfilled the criteria of angina. Coronary atherosclerosis was more common in individuals having angina compared with those with no angina (n=24 602, obstructive coronary atherosclerosis 11.8% vs 5.4%, non-obstructive coronary atherosclerosis 38.9% vs 37.0%, no coronary atherosclerosis 49.4% vs 57.7%, all p<0.001). Factors independently associated with angina were birthplace outside of Sweden (OR 2.58 (95% CI 2.10 to 2.92)), low educational level (OR 1.41 (1.10 to 1.79)), unemployment (OR 1.51 (1.27 to 1.81)), poor economic status (OR 1.85 (1.38 to 2.47)), symptoms of depression (OR 1.63 (1.38 to 1.92)) and high degree of stress (OR 2.92 (1.80 to 4.73)). Conclusion Angina pectoris symptoms are common (3.5%) among middle-aged individuals of the general population of Sweden, though with low association to obstructive coronary atherosclerosis. Sociodemographic and psychological factors are highly associated with angina symptoms, irrespective of degree of coronary atherosclerosis.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
angina pectoris, atherosclerosis, computed tomography angiography, coronary artery disease, epidemiology
in
Heart
volume
109
issue
19
pages
10 pages
publisher
BMJ Publishing Group
external identifiers
  • pmid:37225242
  • scopus:85164336557
ISSN
1355-6037
DOI
10.1136/heartjnl-2023-322345
language
English
LU publication?
yes
id
8add6523-a04a-4baf-9007-48cdc9525e92
date added to LUP
2023-10-16 14:45:09
date last changed
2024-04-19 02:25:07
@article{8add6523-a04a-4baf-9007-48cdc9525e92,
  abstract     = {{<p>Objective To assess the contemporary prevalence of, and factors associated with angina pectoris symptoms, and to examine the relationship to coronary atherosclerosis in a middle-aged, general population. Methods Data were based on the Swedish CArdioPulmonary bioImage Study (SCAPIS), in which 30 154 individuals were randomly recruited from the general population between 2013 and 2018. Participants that completed the Rose Angina Questionnaire were included and categorised as angina or no angina. Subjects with a valid coronary CT angiography (CCTA) were categorised by degree of coronary atherosclerosis; ≥50% obstruction (obstructive coronary atherosclerosis), &lt;50% obstruction or any atheromatosis (non-obstructive coronary atherosclerosis) or none (no coronary atherosclerosis). Results The study population consisted of 28 974 questionnaire responders (median age 57.4 years, female 51.6%, hypertension 19.9%, hyperlipidaemia 7.9%, diabetes mellitus 3.7%), of which 1025 (3.5%) fulfilled the criteria of angina. Coronary atherosclerosis was more common in individuals having angina compared with those with no angina (n=24 602, obstructive coronary atherosclerosis 11.8% vs 5.4%, non-obstructive coronary atherosclerosis 38.9% vs 37.0%, no coronary atherosclerosis 49.4% vs 57.7%, all p&lt;0.001). Factors independently associated with angina were birthplace outside of Sweden (OR 2.58 (95% CI 2.10 to 2.92)), low educational level (OR 1.41 (1.10 to 1.79)), unemployment (OR 1.51 (1.27 to 1.81)), poor economic status (OR 1.85 (1.38 to 2.47)), symptoms of depression (OR 1.63 (1.38 to 1.92)) and high degree of stress (OR 2.92 (1.80 to 4.73)). Conclusion Angina pectoris symptoms are common (3.5%) among middle-aged individuals of the general population of Sweden, though with low association to obstructive coronary atherosclerosis. Sociodemographic and psychological factors are highly associated with angina symptoms, irrespective of degree of coronary atherosclerosis.</p>}},
  author       = {{Welén Schef, Kerstin and Tornvall, Per and Alfredsson, Joakim and Hagström, Emil and Ravn-Fischer, Annica and Soderberg, Stefan and Yndigegn, Troels and Jernberg, Tomas}},
  issn         = {{1355-6037}},
  keywords     = {{angina pectoris; atherosclerosis; computed tomography angiography; coronary artery disease; epidemiology}},
  language     = {{eng}},
  number       = {{19}},
  pages        = {{1450--1459}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{Heart}},
  title        = {{Prevalence of angina pectoris and association with coronary atherosclerosis in a general population}},
  url          = {{http://dx.doi.org/10.1136/heartjnl-2023-322345}},
  doi          = {{10.1136/heartjnl-2023-322345}},
  volume       = {{109}},
  year         = {{2023}},
}