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Age variation in the association between angiographic coronary disease and angina from the Coronary Artery Surgery
L D Fisher1, C Maynard, A W Rademaker
1Department of Biostatistics, University of Washington School of Public Health, Seattle.
Insights
Older patients with coronary artery disease experience more severe angina pectoris, even with similar disease levels. Age is an independent predictor of angina presence and severity, suggesting physiological factors and lifestyle contribute.
Area of Science:
- Cardiology
- Geriatric Medicine
- Clinical Research
Background:
- Coronary Artery Surgery Study (CASS) enrolled 19,153 patients between 1974-1979.
- Patients studied had chest pain and underwent angiography, excluding those with prior cardiac surgery.
Purpose of the Study:
- To determine if older patients experience greater presence and severity of angina pectoris compared to younger patients, for fixed levels of coronary artery disease.
- To investigate the independent predictive value of age on angina symptoms in patients with coronary artery disease.
Main Methods:
- Analysis of non-randomized patient data from the Coronary Artery Surgery Study (CASS).
- Logistic regression analysis was employed to adjust for covariates and assess the relationship between age and angina.
- Comparison of angina presence and severity between different age groups with similar coronary artery disease extent.
Main Results:
- Older patients were more likely to have angina pectoris and exhibit more severe symptoms than younger patients, given the same extent of coronary artery disease.
- Age was identified as a significant, independent predictor for both the presence and severity of angina.
- Physiological factors related to aging, disease progression, and deconditioning were suggested as potential explanations.
Conclusions:
- Age is an independent risk factor for the presence and severity of angina pectoris in patients with coronary artery disease.
- Findings suggest that aging processes, disease characteristics, and lifestyle factors contribute to increased angina in older individuals.
- Referral patterns and age-specific angina prevalence may also influence observed differences.
Abstract:
Between July 1974 and May 1979, 19,153 non-randomized patients without prior cardiac surgery and with chest pain were studied angiographically and enrolled in the Coronary Artery Surgery Study (CASS). The primary question addressed by this paper is: for fixed levels of coronary artery disease, are the presence and severity of angina pectoris greater for older than for younger patients? For those with the same extent of disease, older patients were more likely to have angina and to exhibit more severe symptoms. After adjustment for covariates using logistic regression analysis, age was found to be an important, independent predictor of the presence and severity of angina. There are many possible explanations for these findings, although physiologic factors related to aging, the disease process, and deconditioning associated with an increased sedentary life style seem most reasonable. Another possibility has to do with referral patterns for study and the prevalence of angina in the different age groups.