Incidence and Prognostic Implications of Stable Angina Pectoris Among Women and Men

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Abstract
The public health impact of stable angina, particularly among women, is poorly understood. In the United States1 and many developed countries, coronary disease is the most common cause of death in women,2 and among women, stable angina is the most common initial symptomatic presentation.3 Despite the declining incidence of myocardial infarction, the prevalence of angina remains high,4,5 and direct costs in the United States in 2000 have been estimated at up to $75 billion.6 Major population studies of coronary disease in women7,8 have focused on patients hospitalized for acute coronary syndromes or fatal coronary disease, to the near exclusion of chronic stable angina. Because most angina patients are treated symptomatically with nitrates,5 and because prescribing data are more complete and standardized than diagnostic coding in primary care, nitrate use is a commonly used measure of the burden of treated angina in the community.5,9 However, there is an apparent paradox; angina prevalence in women is similar to that in men,10,11 in contrast with the marked male excess of myocardial infarction incidence12 and angiographically demonstrated coronary artery disease.13 This has led some to consider population estimates of angina in women as “soft,”14 not reflecting coronary pathologic findings.

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