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Repeatability and validity of the Rose questionnaire for angina pectoris in the Atherosclerosis Risk in Communities
P D Sorlie1, L Cooper, P J Schreiner
1Epidemiology and Biometry Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
Insights
The Rose questionnaire effectively identifies angina pectoris (AP) in epidemiological studies. Multiple persistent reports and severe AP indicate more severe cardiovascular disease, but even a single report is valid for assessing risk factors.
Area of Science:
- Cardiovascular epidemiology
- Clinical assessment of cardiovascular disease
Background:
- Angina pectoris (AP) is a critical indicator of cardiovascular disease.
- The Rose questionnaire is a widely used tool for assessing AP in population studies.
Purpose of the Study:
- To assess the repeatability and validity of the Rose questionnaire for diagnosing angina pectoris (AP).
- To evaluate AP's association with cardiovascular risk factors and disease markers.
Main Methods:
- Administered the Rose questionnaire annually to nearly 16,000 participants in the Atherosclerosis Risk in Communities Study.
- Assessed repeatability using kappa statistics and validity by comparing AP to risk factors, prevalent heart disease, medication use, and carotid artery wall thickness.
Main Results:
- Repeatability varied by race and sex, with white men showing the highest agreement.
- Persistent AP and severe AP (pain on level walking) were associated with thicker carotid arteries, smoking, prior heart attack, and chest pain medication use.
Conclusions:
- The Rose questionnaire demonstrates moderate validity for AP assessment in epidemiological studies.
- Multiple reports and severe AP grading correlate with more severe cardiovascular disease, supporting its utility in research.
Abstract:
Angina pectoris (AP) as determined by the Rose questionnaire was assessed in nearly 16,000 black and white men and women participating in the Atherosclerosis Risk in communities Study, a population study of cardiovascular disease in four communities. The questionnaire was administered at yearly intervals and estimates of repeatability were made. Validity was assessed indirectly by comparing Rose AP to risk factors, prevalent heart disease, medication use, and thickness of carotid artery walls as measured by B-mode ultrasound. Using kappa statistics for agreement of positive Rose AP determinations taken 1 year apart, white men show a higher level of agreement than white women (average kappa 0.36 for white men, 0.30 for white women), and whites show a higher level of agreement than blacks (average kappa 0.23 and 0.22 for black men and women, respectively). Rose AP that persists for more than one determination is associated with thicker carotid artery walls, greater amounts of cigarette smoking, greater prevalence of reported heart attack, and greater use of chest pain medications. A single determination of severe Rose AP is also associated with thicker carotid artery walls. These data suggest that multiple reports and the more severe grading of Rose AP (pain reported while walking on the level) are likely to indicate more severe disease; however, a single report using the Rose questionnaire appears valid, i.e., moderately associated with disease and risk factors, and appropriate for use in epidemiological studies.