Abstract
The frequency of coronary heart disease in a community is usually measured by myocardial infarction incidence and mortality rates. The measurement of the prevalence of angina pectoris may, however, become a convenient way of assessing coronary heart disease morbidity in the future. The aim of this study was to determine the prevalence of angina and validity of the Rose questionnaire in the Spanish population aged from 45 to 74 years. A cross-sectional study was conducted in 10,248 subjects (45–74 years), representative of the Spanish population. The WHO Rose questionnaire was used and a construct validation against regional mortality rates and cardiovascular risk factor prevalence was devised. The overall angina prevalence increased with age both in men and women, but was higher in the latter (7.3% and 7.7%, respectively). Angina prevalence also increased with the number of cardiovascular risk factors present and correlated with regional CHD mortality rates (r = 0.66). Sensitivity and specificity results of the Rose questionnaire were low when tested against exercise test (52.9% and 52.1%, respectively). As conclusions, Rose questionnaire is a reliable tool for assessing angina prevalence in the Spanish population which is similar to that of other industrialized countries with higher myocardial infarction morbidity and mortality.
Similar content being viewed by others
References
WHO MONICA Project Investigators. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Circulation 1994; 90: 583–612.
Recommendations of the Task Force of the European Society of Cardiology. Management of stable angina pectoris. Eur Heart J 1997; 18: 394–413.
Villar Alvarez F, Banegas Banegas JR, Rodriguez Artalejo F, del Rey Calero J. Mortalidad por causas car-diovasculares en España y sus comunidades autónomas (1975–1992). Med Clínica (Barc) 1998; 9: 321–327.
Pérez G, Pena A, Sala J, Roset P, Masiá R, Marrugat J, and the REGICOR investigators. Acute myocardial infarction case fatality, incidence and mortality rates in a population registry in the province of Girona, Spain, 1990 to 1992. Int J Epidemiol 1998; 27: 599–604.
Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arvelier D, Rajakangas AM, Pajak A. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 1994; 90; 583–612.
Rose GA, Blackburn H, Gillum RF, Prineas RJ. Cardiovascular survey methods, 2nd edition. Geneva: World Health Organization, 1982.
Streiner DL, Norman GR. Health measurement scales. A practical guide to their development and use. Oxford: Oxford University Press, 1989: 113–120.
De los Reyes M, Banegas JR, Villar F. Información epidemiológica actual sobre las enfermedades cardiovasculares en España. Utilidad de los Registros Nacionales de Cardiología. Rev Esp Cardiol 1994, 47: 648–657.
ESC Working group on exercise physiology, physiopathology, and electrocardiography. Guidelines for cardiac exercise testing. Eur Heart J 1993; 14: 969–988.
LaCroix AZ, Guraalnik JM, Curb DJ, Wallace RB, Ostfeld AM, Hennekens CH. Chest pain and coronary heart disease mortality among older men and women in three communities. Circulation 1990; 81: 437–446.
LaCroix AZ, Haynes SG, Savege DD, Havlik RJ. Rose questionnaire angina among United States black, white, and Mexican-American women and men. Prevalence and correlates from the second National and Hispanic Health and Nutrition Examination Surveys. Am J Epidemiol 1980: 129: 669–686.
Abernathy JR, Thorn MS, Trobaugh GB, Ekelund L-G, Maciolowski M, Lupovetsky B, Shelnova S, Zhurovsky G, Shestov D, Deev A for the U.S.-U.R.S.S. Steering Committee for Cardiovascular area 1: Pathogenesis and atherosclerosis: Circulation 1988; 77: 270–278.
Wilcosky T, Harrys R, Weissfeld L. The prevalence and correlates of Rose Questionnaire angina among women and men in the Lipid Research Clinics Program Prevalence Study Population. Am J Epidemiol 1987; 125: 400–409.
Kuller L, Borhani N, Furberg C, Gardin J, Manolio T, O'Leary D, Psaty B, Robbins J. Prevalence of subclinical atherosclerosis and cardiovascular disease and association with risk factors in the Cardiovascular Health Study. Am J Epidemiol 1994; 139: 1164–1179.
Smith WC, Kenicer MB, Tunstall-Pedoe H, Clark EC, Crombie IK. Prevalence of coronary heart disease in Scotland: Scottish Heart Health Study. Br Heart J 1990; 64: 295–298.
Shaper AG, Cook DB, Walker M, MacFarlane PW. Prevalence of ischaemic heart disease in middle-aged British men. Br Heart J 1984; 51: 595–605.
Reunanen A, Aromaa A, Pyorola K, Punsar S, Maatela J, Knekt P. The social insurance institution's coronary heart disease study. Baseline data and 5-year mortality experience. Acta Med Scand Suppl 1983; 673: 1–120.
Sigurdsson E, Thorggeirsson G, Siggvaldason H, Sigfusson N. Prevalence of coronary heart disease in Icelandic men 1968–1986. The Reykjavik Study. Eur Heart J 1993; 14: 584–591.
Krogh V, Trevisan M, Panico S, Farinaro E, Mancini M, Menotti A, Ricci G and Research Group ATS-RF2 of the Italian National Research Council. Prevalence and correlates of angina pectoris in the Italian nine communities study. Epidemiology 1991; 2: 26–32.
Mitchell BD, Hazuda HP, Haffner SM, Patterson JK, Stern MP. High prevalence of angina pectoris in Mexican-American men. A population with reduced risk of myocardial infarction. Ann Epidemiol 1991; 1: 415–426.
Masiá R, Pena A, Marrugat J, Sala J, Vila J, Pavesi M, Covas MI, Aubó C, Elosua R and the REGICOR Investigators. High prevalence of cardiovascular risk factors in Gerona, Spain, a province with low myocardial infarction incidence. J Epidemiol Community Health 1998; 52: 707–715.
Harris RB, Weissfeld LA. Gender differences in the reliability of reporting symptoms of angina pectoris. J Clin Epidemiol 1991; 44: 1071–1078.
Sorlie PD, Cooper L, Schreiner PJ, Rosamond W, Szklo M. Repeatability and Validity of the Rose questionnaire for angina pectoris in the Atherosclerosis Risk in Communities Study. J Clin Epidemiol 1996; 49: 719–725.
Garber CE, Carleton RA, Heller GV. Comparison of Rose questionnaire angina to exercise thallium scintigraphy: Different findings in males and females. J Clin Epidemiol 1992; 45: 715–720.
Lerner DJ, Kannel WB. Patterns of coronary heart disease morbidity and mortality in the sexes: A 26-year follow-up of the Framingham population. Am Heart J 1986; 111: 383–390.
Cannon PJ, Connell PA, Stockley IH, Garner ST, Hampton JR. Prevalence of angina as assessed by a survey of prescriptors for nitrates. Lancet 1988; 1: 979–981.
Cook DG, Shaper AG, Macfarlane PW. Using the WHO (Rose) angina questionnaire in cardiovascular epidemiology. Int J Epidemiol 1989; 18: 607–613.
Rose GG, Reid DD, Hamilton PJS, McCartney P, Keen H, Jarrett RJ. Myocardial ischaemia, risk factors and death from coronary heart disease. Lancet 1977; 1: 105–109.
Bulpitt CJ, Shipley MJ, Demirovic J, Ebi-Kryston Kl, Markowe HL, Rose G. Predicting death from coronary heart disease using a questionnaire. Int J Epidemiol 1990; 19: 899–904.
Friedman LM, Byington RP, and the beta-blocker heart attack trial research group. Assessment of angina pectoris after myocardial infarction: comparison of ‘Rose questionnaire’ with physician judgement in the beta-blocker heart attack trial. Am J Epidemiol 1985; 121: 555–562.
Barbash GI, White HD, Modan M, Diaz R, Hampton JR, Hheikkila J, Kristinsson A, Moulopoulos S, Paolasso EA, Van der Werf T. Acute myocardial infarction in the young-the role of smoking. The Investigators of the International Tissue Plasminogen Activator/Streptokinase Mortality Trial. Eur Heart J 1995; 16: 313–316.
Barbash GI, Reiner J, White HD, Wilcos RG, Armstrong PW, Sadowski Z, Morris D, Aylward P, Woodlief LH, Topol EJ, Califf RM, Ross AM for the Gusto-I investigators. Evaluation of paradoxic beneficial effects of smoking in patients receiving thrombolytic therapy for acute myocardial infarction: mechanism of the 'smoker's paradox’ from the GUSTO-I trial, with angiographic insights. Global utilization of streptokinase and tissue-plasminogen activator for occluded coronary arteries. J Am Coll Cardiol 1995; 26: 1222–1229.
Bass EB, Follansbee WP, Orchard TJ. Comparison of a supplemented Rose questionnaire to exercise thallium testing in men and women. J Clin Epidemiol 1989; 42: 385–394.
Patterson RE, Eng C, Horowitz SF. Practical diagnosis of coronary artery disease. A Bayes theorem normogram to correlate clinical data with non-invasive exercise test. Am J Cardiol 1984; 53: 252–256.
Medalie JH, Snyder M, Groen JJ, Neufeld HN, Goldbourt U, Riss E. Angina pectoris among 10,000 men. 5-year incidence and univariate analysis. Am J Med 1973; 55: 583–594.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Cosín, J., Asín, E., Marrugat, J. et al. Prevalence of angina pectoris in Spain. Eur J Epidemiol 15, 323–330 (1999). https://doi.org/10.1023/A:1007542700074
Issue Date:
DOI: https://doi.org/10.1023/A:1007542700074