Original article
Prevalence of Stable Angina in Spain. Results of the OFRECE StudyPrevalencia de angina estable en España. Resultados del estudio OFRECE

https://doi.org/10.1016/j.rec.2014.09.020Get rights and content

Abstract

Introduction and objectives

The objective of the OFRECE study was to estimate the prevalence of stable angina in Spain. This prevalence is currently unknown, due to a lack of recent studies and to changes in the epidemiology and treatment of ischemic heart disease.

Methods

This cross-sectional study involved a representative sample of the Spanish population aged 40 years or older, obtained via 2-stage random sampling: in the first stage, primary care physicians were randomly selected from each Spanish province, whereas in the second stage 20 people were selected from the population assigned to each physician. The prevalence was weighted by age, sex, and geographical area. Participants were classified as having angina if they met the “definite angina” criteria of the Rose questionnaire and as having confirmed angina if the angina was confirmed by a cardiologist or if they had a history of acute ischemic heart disease or revascularization.

Results

Of the 11 831 people invited to participate, 8378 (71%) were analyzed (mean age, 59.2 years). The weighted prevalence of definite angina (Rose) was 2.6% (95% confidence interval, 2.1%-3.1%) and was higher in women (2.9%) than in men (2.2%), whereas that of confirmed angina was 1.4% (95% confidence interval, 1.0%-1.8%), without differences between men (1.5%) and women (1.3%). The prevalence of definite angina (Rose) increased with age (0.7% in patients aged 40 to 49 years and 7.1% in those aged 70 years or older), history of cardiovascular disease, and cardiovascular risk factors, except smoking.

Conclusions

The prevalence of definite angina (Rose) in the Spanish population aged 40 years or older was 2.6%, whereas that of confirmed angina was 1.4%. Both prevalences increased with age, cardiovascular risk factors, and cardiovascular history.

Resumen

Introducción y objetivos

El objetivo del estudio OFRECE fue estimar la prevalencia de angina estable en España. Esta es actualmente desconocida por falta de estudios recientes y cambios en la epidemiología y el tratamiento de la cardiopatía isquémica.

Métodos

Estudio transversal. Se obtuvo una muestra representativa de la población española de edad mayor o igual a 40 años mediante muestreo aleatorio en dos etapas: la primera fue una selección aleatoria de médicos de atención primaria de cada provincia y la segunda, una selección de 20 individuos de la población asignada a cada médico. La prevalencia se ponderó por edad, sexo y área geográfica. Se clasificó a los participantes como pacientes con angina si cumplían criterios de «angina segura» del cuestionario de Rose y como angina confirmada si además tenían antecedentes de cardiopatía isquémica aguda, revascularización o confirmación tras evaluación cardiológica.

Resultados

Se analizó a 8.378 personas (media de edad, 59,2 años), el 71% de las 11.831 invitadas a participar. La prevalencia ponderada de angina segura (Rose) fue del 2,6% (intervalo de confianza del 95%, 2,1-3,1%), mayor en mujeres (2,9%) que en varones (2,2%), y la de angina confirmada, del 1,4% (intervalo de confianza del 95%, 1,0-1,8%) sin diferencias entre varones (1,5%) y mujeres (1,3%). La prevalencia se incrementó con la edad (angina segura, el 0,7% en el grupo de 40-49 años y el 7,1% en el de mayor o igual a 70 años), los antecedentes de enfermedad cardiovascular y los factores de riesgo cardiovascular, salvo el tabaquismo.

Conclusiones

La prevalencia de angina segura (Rose) en la población española de edad mayor o igual a 40 años es del 2,6% y la de angina confirmada, del 1,4%, y ambas se incrementan con la edad, los factores de riesgo cardiovascular y los antecedentes cardiovasculares.

Section snippets

INTRODUCTION

In recent decades, significant advances have been made in the understanding of the pathophysiology and pharmacological and interventional treatment of coronary artery disease. At the same time, developed countries have launched preventive interventions against cardiovascular risk factors (CVRFs). Both aspects should have contributed to improve the epidemiological data and prognosis of ischemic heart disease.1, 2, 3 Although the prevalence of stable angina in Spain has been evaluated in various

Design and Definitions

The present cross-sectional study of the Spanish population aged 40 years or older was conducted in primary care (PC). The OFRECE study was approved by the Ethics Committee for Clinical Research of Hospital Universitario de Basurto. The main characteristics of its methodology have already been described.10 Briefly, to obtain a representative sample of the Spanish population, for each Spanish province one hospital and health care area (2 in Madrid and Barcelona) and one cardiologist were

RESULTS

The mean age of the 8378 participants in the analysis of angina prevalence in the OFRECE study was 59.2 (95%CI, 58.6-59.7) years; 52.6% were women. The general characteristics of the studied population are shown in Table 1, as well as comparisons between patients with definite (Rose questionnaire) or confirmed angina and the rest of the population. The overall population showed high prevalences of risk factors and certain antecedents. Notably, 45.3% of the population was hypertensive, 4.9% had

DISCUSSION

The prevalence of stable angina is difficult to establish because its diagnosis is eminently clinical4 and complex, expensive population studies are required for a reliable estimation. Most studies have used the Rose questionnaire,11 which, despite its limitations, is recommended by the World Health Organization for epidemiological studies12 and has been validated for use in Spain.8 This questionnaire is useful because it shows a good correlation with cardiovascular morbidity and mortality11, 12

CONCLUSIONS

The prevalence of stable angina in the Spanish population aged 40 years or older was 2.6% using the Rose questionnaire definition of definite angina and 1.4% when history of ACS or revascularization was also required. The data indicate that the prevalence of stable angina in Spain has decreased in the last decade and is lower than the overall rate observed in Europe and the United States. The prevalence increased with age and an association was seen between angina and the main CVRFs and history

FUNDING

The OFRECE study was supported by the Research Agency of the Spanish Society of Cardiology (Agencia de Investigación de la Sociedad Española de Cardiología). This study has been financed by a grant from the Observatorio de la Mujer of the Agencia de Calidad del Ministerio de Sanidad and by an unconditional grant from SANOFI (which was not involved in the study design, data analysis, or preparation of the final manuscript).

CONFLICTS OF INTERESTS

None declared.

References (28)

  • X. Borras et al.

    Estudio de la angina estable en España y su impacto en la calidad de vida del paciente. Registro AVANCE

    Rev Esp Cardiol.

    (2012)
  • G.A. Mensah et al.

    An overview of cardiovascular disease burden in the United States

    Health Aff (Millwood).

    (2007)
  • A.S. Go et al.

    Executive summary: heart disease and stroke statistics—2014 update: a report from the American Heart Association

    Circulation.

    (2014)
  • G. Montalescot et al.

    2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology.

    Eur Heart J.

    (2013)

    • Cited by (0)

    ◊

    A list of the contributors to the OFRECE (Observación de Fibrilación y Enfermedad Coronaria en España [Observation of Fibrillation and Coronary Disease in Spain]) study is included in Appendix 1 of the supplementary material.

    View full text
    Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L. All rights reserved.