Rose questionnaire is not what it seems

EDITOR—Macleod et al's paper on stress and cardiovascular disease tells us two things.1 Firstly, the Rose angina questionnaire rather inconveniently does not just measure angina in the sense understood by cardiologists.2 Instead it measures chest pain as understood by everyone else.

Most cases of chest pain in the general population are not due to heart disease, and even in middle aged Scottish men the prevalence of coronary heart disease is low, so the positive predictivevalue of the Rose questionnaire will be poor.3 The relation between stress and chest pain that the questionnaire measures is only a “bias” in as much as it does not fit into the view of cardiovascular epidemiologists. The effect is real (and has important clinical implications to cardiologists) in that the Rose questionnaire is a superb measure of anxiety in young people but will mislead those who interpret its results too credulously.3 The effect probably accounts for anomalies such as the higher rates of angina in women despite their lower rates of coronary heart disease.4

The second thing the paper tells us is that a weak measure of …