Could chest pain be an early warning sign of second cardiovascular events?

The main aim of this article was to determine whether there was a link between the frequency of angina pectoris (chest pain) and cardiovascular events. 

Patients with coronary artery disease have insufficient blood flow to the muscles of the heart. Blood flow to the heart muscles can be slowed by plaque (a fatty substance that can build-up in the blood vessels). This plaque build up can reduce the amount of oxygen available to the heart muscles. A reduced amount of oxygen to the heart muscles will reduce functionality and may put a patient at a greater risk of heart attack. 

This build-up of plaque can also cause angina pectoris (AP), or chest pain. AP is associated with an increased risk of cardiovascular events (such as a heart attack). It is not clear, however, whether AP can predict a second cardiovascular event in a patient.

The study included 1,023 patients who had previously experienced a cardiovascular event or showed signs of cardiovascular damage. Patients answered a questionnaire to determine their frequency of AP and the physical limitations it caused. Patients were then divided into three groups based on the frequency of their AP: never, monthly, or dailyweekly/daily. Patients were contacted by telephone once a year to answer questions about health and cardiovascular events. Patients were followed for an average of 8.9 years.

At the start of the study, 62% reported no AP, 27% reported monthly AP, and 11% reported daily/weekly AP. 

Patients with daily/weekly AP were 2.4 times more likely to be hospitalized for AP, and were 1.7 times more likely to need revascularization (a surgical method to restore blood flow to blocked vessels) compared to those without AP. Daily/weekly AP was also associated with a 40% increase in mortality risk. AP frequency was not associated with the risk of a second heart attack.

Greater physical limitations due to AP were associated with increased risks of hospitalization, revascularization, heart failure and mortality.

This study concluded that AP frequency predicted future cardiovascular events and mortality in patients with coronary artery disease. 

The majority of the participants in this study were men. Previous studies have shown that there may be a greater risk for women experiencing AP. 

If you are experiencing chest pain of discomfort, consult with your doctor.