Natural history of angina pectoris in the Framingham study. Prognosis and survival

The evolution of 303 cases of angina in a general population sample of 5,127 persons was ascertained and revealed that the lot of the angina victim is not a happy one. Prognosis as to survival and progression to more serious coronary manifestations was discouraging in men. One in 4 men with angina can expect to have a coronary attack within 5 years. The risk is half this for women. About 30 percent of those over 55 will die within 8 years, and 44 percent of the coronary deaths will be sudden. Mortality was close to that which follows the posthospital phase of myocardial infarction. Surprisingly, survival in men with uncomplicated angina was no better than that for angina which follows an infarction. Angina was more likely to be the presenting complaint of coronary disease in women (65 percent) than in men (37 percent). In men 45 percent of angina arose out of myocardial infarction compared to 15 percent in women. Half of those sustaining initial myocardial infarctions had angina following it, 31 percent experiencing it for the first time. In those with angina who sustained an infarction, the angina disappeared in only 15 percent of men and no women, a rate lower than the 30 percent spontaneous rate of disappearance. Only 23 percent of infarctions were preceded by angina. Almost 1 in 4 myocardial infarctions were silent or went unrecognized. Such infarctions were rare in persons with prior angina.