Chest pain on questionnaire and prediction of major ischaemic heart disease events in men

Objective To examine the prediction of major ischaemic heartdisease events by questionnaire-assessed chest pain and othersymptoms. Design Population-based prospective study. Subjects 7735 randomly selected men, aged 40–59 yearsat entry. Methods Symptoms and history of diagnosed ischaemic heart diseasewere ascertained by administered questionnaire at baseline.Follow-up was for an average of 14·7 years, for firstmajor ischaemic heart disease event. Results During follow-up, 969 men had a major ischaemic heartdisease event. ‘Definite’ angina (chest pain fulfillingall WHO criteria) and ‘possible’ angina (exertionalchest pain without all other WHO criteria) were associated withsimilar ischaemic heart disease outcome, and a single combinedangina category was used. In the whole cohort, the relativerisks (95% CI) of a major ischaemic heart disease event were2·03 (1·61, 2·57) for angina only, 2·13(1·72, 2·63) for possible myocardial infarctiononly and 4·50 (3·57, 5·66) for angina pluspossible myocardial infarction, compared to no chest pain. Therelative risk for recall of an ischaemic heart disease diagnosiswas 3·98 (3·36, 4·71). Only 33% of menwith angina or possible myocardial infarction symptoms recalleda previous ischaemic heart disease diagnosis. In men withoutrecall of an ischaemic heart disease diagnosis (in whom 82%of events during follow-up occurred), chest pain symptoms remainedpredictive of major ischaemic heart disease events with relativerisks (95% CI) of 1·69 (1·27, 2·24) forangina only, 1·49 (1·12, 1·97) for possiblemyocardial infarction only and 2·55 (1·44, 4·53)for angina plus possible myocardial infarction. ‘Otherchest pain’ increased risk of a major ischaemic heartdisease event by 1·19 (1·01, 1·40) comparedto no chest pain. Symptoms of breathlessness or calf pain onwalking increased ischaemic heart disease risk in men with ‘otherchest pain’ and in men without chest pain, but had nofurther effect on ischaemic heart disease risk in men with symptomsof angina or possible myocardial infarction. Conclusions In defining angina by chest pain questionnaire,the exertional component is the crucial criterion. When usingquestionnaire-assessed symptoms to determine ischaemic heartdisease risk, information on previous ischaemic heart diseasediagnoses should be taken into account. The majority of menwith angina or possible myocardial infarction symptoms do nothave a diagnosis of ischaemic heart disease, but they remainat significantly increased risk of a major ischaemic heart diseaseevent. The value of breathlessness and calf pain on walkingin stratifying ischaemic heart disease risk is restricted tomen with ‘other chest pain’ or no chest pain.