Does Rose angina in midlife women matter? Further evidence from the Royal College of General Practitioners' Oral Contraception Study

Background and aims

Globally, ischaemic heart disease (IHD) is a leading cause of death among women; however, disparities remain in the diagnosis and treatment of IHD between females and males. There is limited evidence about mortality risks among women with symptoms of IHD who remain undiagnosed. We re-examined the mortality risks in midlife women who completed the Rose Angina Questionnaire, among a subset of the Royal College of General Practitioners' Oral Contraception Study cohort.

Methods

8694 women in the cohort completed the Rose Angina Questionnaire, enquiring about symptoms of exertional chest pain, likely angina, and prior myocardial infarction. The women were followed for vital status and cause of death information until 30 June 2022. The relationship between different types of Rose angina and all-cause and cause-specific mortality was examined using Kaplan-Meier survival curves, and unadjusted and adjusted Cox regression.

Results

After 27 years, 3263 (37.5 %) women had died. Compared with women who did not report symptoms, women with Rose angina had an increased risk of all-cause and IHD death. Women without a prior IHD diagnosis and grade II Rose angina at survey had the highest all-cause (adjusted hazard ratio [aHR] 2.14, 95 % confidence interval [CI] 1.55 to 2.97) and IHD-specific (aHR 3.18, 95 % CI 1.64 to 6.17) mortality risks.

Conclusions

Women reporting Rose chest pain had a higher risk of all-cause and IHD death, even in the absence of a prior IHD history. These findings highlight the importance of identifying symptomatic women in midlife, so their IHD risk can be managed appropriately by their healthcare providers.