Varies greatly from 20% to 80%.

The exertional component of the symptoms

is crucial to the diagnostic accuracy of the questionnaire, and its
performance to be less accurate in women.
The prevelance of angina in community studies increase sharply with age in
both sexes from 0.1% in women aged 45-54 to 10-15% in women aged 65-74
and from 2-5% in men aged 45-54 to 10-20% in men aged 65-74.therefore, it
can be estimated that in most European countries, 20.000-40.000 individuals
of the population per million suffer from angina.
Community-based information on the incidence of angina pectoris is derived
from prospective, epidemiologic studies with repeated examinations of the
cohort. Such studies have been scarce over recent years. Available data,
from the Seven Countries study, studies in the UK, the Israel Ischaemic Heart
Disease study, The Honohulu Heart study, the Framingham study and others,
suggest an annual incidence of uncomplicated angina pectoris of ~0.5% in
westen populations aged>40, but with geographic variations evident.
A more recent study, using a different definition of angina based on case
description by clinicians, which defined angina pectoris as the association of
chest pain at rest or on exertion with one positive finding from a
cardiovascular examination such as arteriography, scintigraphy, exercise
testing, or resting ECG, confirm geographical variations in the incidence of
angina which occur in parallel with observed international differences in
corony heart disease (CHD) mortality. The incidence of angina pectoris as a
first coronary event was approximately twice high in Belfast compared with
France (5.4 per 1000 person-years compared with 2.6).
Temporal trends suggest a decrease in the prevelance of angina pectoris in
recent decades in line with falling cardiovascular mortality rates observed in
the MONICA study. However, the prevalence of a history of diagnosed CHD
does not appear to have decreased, suggesting that although fewer people
are developing angina due to changes in life style and risk factors, those who
have coronary disease are living longer with the disease. Improved
sensitivity of diagnostic tools may additionally contribute to the
contemporary high prevalence of diagnosed CHD.
Natural History and Prognosis
Information on the prognosis associated with chronis stable angina is derived
from long term prospective, population based studies, clinical trials of
antianginal therapy, and observationalregistries, with selection bias an

important factor to consider when evaluating and comparing the available

data. European data estimate the cardiovascular disease (CVD) mortality
rate and CHD mortality rates for men with Rose Questionnaire angina atao
be between 2.6 and 17.6 per 1000 patient-years between the 1970s and
1990s. Data from the Framingham Heart Study showed that for men and
women with an initial clinical presentasion of stable angina, the 2-years
incidence rates of non-fatal MI and CHD death were 14.3 and 5.5% in men
and 6.2 and 3.8% in women, respectively. More contemporary data regarding
prognosis can be gleaned from clinical trials of antianginal therapy and/or
revascularization, although these data are blased by the selected nature of
the populations studied. From these, estimates for annual mortality rates
range from 0.9-1.4% per annum, with an annual incidence of non-fatal MI
between 0.5% (INVEST) and 2.6% (TIBET). These estimates are consistent
with observational registry data.
However, within the population with stable angina, an individuals prognosis
can vary considerable, by up to 10 fold, dependent on baseline clinical,
functional and anatomical factors. Therefore, prognostic assessmengt is an
important part of the management of patients with stable angina. On the one
hand, it