Prevalence, Correlates and Associated Mortality of Undiagnosed Angina in People Without Established Cardiovascular Disease in US Adults: From the National Health and Nutrition Examination Survey 2001-2018

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Background: The prevalence, correlates and associated mortality of undiagnosed angina in persons without established cardiovascular disease in the USA has not been established. We set out to establish the prevalence and correlates as well as assess mortality outcomes.

Methods and Results: Included in our study were National Health and Nutrition Examination Survey (NHANES) participants from 2001-2018, aged ≥40years and free of established cardiovascular disease. The diagnosis of angina was established using the Rose Angina Questionnaire. The prevalence of undiagnosed angina was 1.99% (95% confidence interval (CI) 1.79- 2.20), corresponding to 2.6 million (95% CI 2.3 - 2.9) persons. In multivariable analysis, female sex (aOR 1.75, 1.37-2.25), lower education attainment (aOR 1.59, 1.08-2.33), obesity (aOR 2.68, 1.19-2.37), ever smokers (aOR, 1.51, 1.17-1.94), low income(Poverty index ratio <3) aOR 1.89, 1.44-2.47), and hypertension (aOR 1.48, 1.12-1.96) were independent correlates of undiagnosed angina. Only 3.8% of all participants with undiagnosed angina were concomitantly on beta blockers, aspirin and a statin. The death rate was 1.08 per 1,000 person months and 1.71 deaths per 1000 person months among those without angina and those with angina, respectively.

Conclusion: The prevalence of undiagnosed angina among US adults ≥40years and older was 2%. Female sex, hypertension, obesity, low income, smoking and low education were associated with undiagnosed angina. Harboring undiagnosed angina was associated with higher risk of mortality.