Risk prediction in stable angina pectoris
Thomas Kahan1, Lennart Forslund, Claes Held
1Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88, Stockholm, Sweden. thomas.kahan@ds.se
Insights
Easily accessible clinical markers like fasting blood glucose and serum creatinine effectively predict cardiovascular complications in stable angina pectoris patients. These common variables offer valuable prognostic information for risk stratification in routine care.
Area of Science:
- Cardiology
- Clinical Medicine
- Preventive Cardiology
Background:
- Stable angina pectoris, while often having a favorable prognosis, requires identification of patients at high risk for cardiovascular complications.
- Numerous novel biomarkers for disease activity and prognosis have been identified.
- The utility of common, readily available clinical markers for prognostic assessment needs evaluation.
Purpose of the Study:
- To assess the prognostic value of easily accessible clinical and demographic variables in patients with stable angina pectoris.
- To determine if routine markers provide sufficient information for cardiovascular risk prediction.
- To identify key predictors of cardiovascular events in this patient population.
Main Methods:
- The Angina Pectoris Prognosis Study in Stockholm enrolled 809 patients with stable angina pectoris.
- Patients received metoprolol or verapamil in a double-blind manner.
- Follow-up included an initial median of 3.4 years and extended registry-based follow-up to 9.1 years.
- Integrated analysis included clinical, mechanistic, biochemical, functional, and psychosocial variables.
- Main outcomes were nonfatal myocardial infarction and combined cardiovascular death.
Main Results:
- A total of 139 patients experienced a primary outcome event.
- Independent predictors of adverse outcomes included age, male sex, elevated fasting blood glucose, increased serum creatinine, and higher leucocyte counts.
- Fasting glucose levels, even in the impaired range, were as predictive as manifest diabetes.
- Smoking, lipids, hypertension, and prior myocardial infarction provided limited additional prognostic value.
- Sexual problems were predictive in men.
Conclusions:
- Readily available clinical and demographic factors provide robust risk prediction for stable angina pectoris.
- Elevated serum creatinine and impaired glucose tolerance are particularly significant predictors of cardiovascular events.
- These findings support the use of common clinical variables for risk stratification in stable angina management.
Background:
Although stable angina pectoris often carries a favourable prognosis, it remains important to identify patients with an increased risk of cardiovascular (CV) complications. Many new markers of disease activity and prognosis have been described. We evaluated whether common and easily accessible markers in everyday care provide sufficient prognostic information.
Materials And Methods:
The Angina Pectoris Prognosis Study in Stockholm treated 809 patients (248 women) with stable angina pectoris with metoprolol or verapamil double blind during a median follow-up of 3·4 years, with a registry-based extended follow-up after 9·1 years. Clinical and mechanistic variables, including lipids and glucose, renal function, ambulatory and exercise-induced ischaemia, heart rate variability, cardiac and vascular ultrasonography, and psychosocial variables were included in an integrated analysis. Main outcome measures were nonfatal myocardial infarction (MI) and CV death combined.
Results:
In all, 139 patients (18 women) suffered a main outcome. Independent predictive variables were (odds ratio [95% confidence intervals]), age (1·04 per year [1·00;1·08], P = 0·041), female sex (0·33 [0·16;0·69], P = 0·001), fasting blood glucose (1.29 per mM [1.14; 1.46], P < 0·001), serum creatinine (1·02 per μM [1·00;1·03], P < 0·001) and leucocyte counts (1·21 per 10(6) cells/L [1·06;1·40], P = 0·008). Smoking habits, lipids and hypertension or a previous MI provided limited additional information. Impaired fasting glucose was as predictive as manifest diabetes and interacted adversely with serum creatinine. Sexual problems were predictive among men.
Conclusions:
Easily accessible clinical and demographic variables provide a good risk prediction in stable angina pectoris. Impaired glucose tolerance and an elevated serum creatinine are particularly important.
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