This Article Free upon publication Full Text Full Text (PDF) CME: Take the course for this article: Circulation: March 25, 2008, Volume 117, Number 12 All Versions of this Article: 117/12/1526    most recent CIRCULATIONAHA.107.720953v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hemingway, H. Articles by Barrett-Connor, E. Search for Related Content PubMed PubMed Citation Articles by Hemingway, H. Articles by Barrett-Connor, E. Related Collections Health policy and outcome research Risk Factors Chronic ischemic heart disease Epidemiology Related Article

(Circulation. 2008;117:1526-1536.)
© 2008 American Heart Association, Inc.

Epidemiology

Prevalence of Angina in Women Versus Men

A Systematic Review and Meta-Analysis of International Variations Across 31 Countries

Harry Hemingway, FRCP; Claudia Langenberg, MD; Jacqueline Damant, MPhil; Chris Frost, PhD; Kalevi Pyörälä, MD; Elizabeth Barrett-Connor, MD

From the Department of Epidemiology and Public Health (H.H., J.D.), University College London Medical School, London, United Kingdom; Medical Research Council Epidemiology Unit (C.L.), Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK; Medical Statistics Unit (C.F.), London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medicine (K.P.), University of Kuopio, Kuopio, Finland; and Department of Family and Preventive Medicine (E.B.-C.), School of Medicine, University of California, San Diego.

Reprint requests to Harry Hemingway, FRCP, Professor of Clinical Epidemiology, Department of Epidemiology and Public Health, University College London Medical School, 1-19 Torrington Place, London WC1E 6BT, United Kingdom. E-mail h.hemingway{at}ucl.ac.uk

Received June 18, 2007; accepted December 31, 2007.

Background— In the absence of previous international comparisons, we sought to systematically evaluate, across time and participant age, the sex ratio in angina prevalence in countries that differ widely in the rate of mortality due to myocardial infarction.

Methods and Results— We searched MEDLINE and EMBASE until February 2006 for healthy population studies published in any language that reported the prevalence of angina (Rose questionnaire) in women and men. We obtained myocardial infarction mortality rates from the World Health Organization. A total of 74 reports of 13 331 angina cases in women and 11 511 cases in men from 31 countries were included. Angina prevalence varied widely across populations, from 0.73% to 14.4% (population weighted mean 6.7%) in women and from 0.76% to 15.1% (population weighted mean 5.7%) in men, and was strongly correlated within populations between the sexes (r=0.80, P<0.0001). Angina prevalence showed a small female excess with a pooled random-effects sex ratio of 1.20 (95% CI 1.14 to 1.28, P<0.0001). This female excess was found across countries with widely differing myocardial infarction mortality rates in women (interquartile range 12.7 to 126.5 per 100 000), was particularly high in the American studies (1.40, 95% CI 1.28 to 1.52), and was higher among nonwhite ethnic groups than among whites. This sex ratio did not differ significantly by participant’s age, the year the survey began, or the sex ratio for mortality due to myocardial infarction.

Conclusions— Over time and at different ages, independent of diagnostic and treatment practices, women have a similar or slightly higher prevalence of angina than men across countries with widely differing myocardial infarction mortality rates.

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CLINICAL PERSPECTIVE

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