Objectives: To examine the hypothesis that glyceryl trinitrate(GTN) may cause headache in patients with normal coronary arteries more often than in patients with obstructive coronary artery disease(CAD). This simple a...Objectives: To examine the hypothesis that glyceryl trinitrate(GTN) may cause headache in patients with normal coronary arteries more often than in patients with obstructive coronary artery disease(CAD). This simple assessment may aid clinicians in the initial evaluation of chest pain syndrome and possible CAD. Patients and methods: 118 patients(66 men and 52 women) with new onset of chest pain were enrolled in this study. Patients were excluded from the study if they had a history of chronic headache, long term nitrates use, or any coronary artery procedures. Mean age of the patients was 62.5 years. Coronary angiography was performed within one month of GTN administration with the usual clinical indications such as recurrent chest pain, abnormal ECG, or abnormal results of stress tests. Thirty patients had normal coronary arteries or minimal or non-obstructive CAD. Eighty eight patients had obstructive CAD defined as luminal narrowing greater than 50%in any one or more of the left or right coronary arteries or their major branches. All the patients had a varying degree of relief of chest pain with GTN administration within 10 minutes. 36%of patients reported significant headache after GTN administration. Results: In patients with normal coronary arteries or minimal CAD, 73%had significant headache caused by sublingual GTN. In patients with obstructive CAD, only 23%had significant headache after GTN use(p< 0.001). There were no differences in patientssex and vascular risk factors concerning the frequency of headache in patients with or without obstructive CAD. Conclusions: GTN causes significantly more frequent headache episodes in patients with normal coronary arteries or minimal CAD than in patients with obstructive CAD. This unique finding may provide clinicians with an additional tool for the differential diagnosis of patients with chest pain syndrome.展开更多
Context: Stable angina pectoris in women has often been considered a “soft”d iagnosis, with less-severe prognostic implications than in men, but large-scal e population studies are lacking. Objective: To determine s...Context: Stable angina pectoris in women has often been considered a “soft”d iagnosis, with less-severe prognostic implications than in men, but large-scal e population studies are lacking. Objective: To determine sex differences in the incidence and prognosis of stable angina in a large ambulatory population. Desi gn: Prospective cohort study using linked national registers. Setting: All munic ipal primary health care centers, hospital outpatient clinics, occupational heal th care services, and the private sector in Finland. Participants: Among ambulat ory patients aged 45 to 89 years who had no history of coronary disease, we defi ned new cases of “nitrate angina”based on nitrate prescription(56 441 women an d 34 885 men) or “test-positive angina”based on abnormal invasive or noninvas ive test results(11 391 women and 15 806 men). Potentially eligible patients wer e evaluated between January 1, 1996, and December 31, 1998. Follow-up ended in December 2001. Main Outcome Measures: Coronary mortality at 4 years(n=7906 death s) and fatal and nonfatal myocardial infarction at 1 year(n=3129 events). Results: The age-standardized annual incidence per 100 population of all cases of ang ina was 2.03 in men and 1.89 in women, with a sex ratio of 1.07(95%confidence i nterval[CI], 1.06-1.09). At every age, nitrate angina in women and men was asso ciated with a similar increase in risk of coronary mortality relative to the gen eral population. Women with test-positive angina who were younger than 75 years had higher coronary-standardized mortality ratios than men; for example, among those aged 55 to 64 years, it was 4.69(95%CI, 3.60-6.11) in women compared wi th 2.40(95%CI, 2.11-2.73) in men(P< .001 for interaction). There was a strong, graded relationship between amount of nitrates used and event rates; women usin g higher doses of nitrates had prognoses comparable with those of men. Among pat ients with diabetes and test-positive angina, age-standardized coronary event rates were 9.9 per 100 person-years in women vs 9.3 in men(P=.69), and the full y adjusted male-female sex ratio was 1.07(95%CI, 0.81-1.41). Conclusions: Wom en have a similarly high incidence of stable angina compared with men. Furthermo re, stable angina in women is associated with increased coronary mortality relat ive to women in the general population and, among easily identifiable clinical s ubgroups, has similarly high absolute rates of prognostic outcomes compared with men.展开更多
文摘Objectives: To examine the hypothesis that glyceryl trinitrate(GTN) may cause headache in patients with normal coronary arteries more often than in patients with obstructive coronary artery disease(CAD). This simple assessment may aid clinicians in the initial evaluation of chest pain syndrome and possible CAD. Patients and methods: 118 patients(66 men and 52 women) with new onset of chest pain were enrolled in this study. Patients were excluded from the study if they had a history of chronic headache, long term nitrates use, or any coronary artery procedures. Mean age of the patients was 62.5 years. Coronary angiography was performed within one month of GTN administration with the usual clinical indications such as recurrent chest pain, abnormal ECG, or abnormal results of stress tests. Thirty patients had normal coronary arteries or minimal or non-obstructive CAD. Eighty eight patients had obstructive CAD defined as luminal narrowing greater than 50%in any one or more of the left or right coronary arteries or their major branches. All the patients had a varying degree of relief of chest pain with GTN administration within 10 minutes. 36%of patients reported significant headache after GTN administration. Results: In patients with normal coronary arteries or minimal CAD, 73%had significant headache caused by sublingual GTN. In patients with obstructive CAD, only 23%had significant headache after GTN use(p< 0.001). There were no differences in patientssex and vascular risk factors concerning the frequency of headache in patients with or without obstructive CAD. Conclusions: GTN causes significantly more frequent headache episodes in patients with normal coronary arteries or minimal CAD than in patients with obstructive CAD. This unique finding may provide clinicians with an additional tool for the differential diagnosis of patients with chest pain syndrome.
文摘Context: Stable angina pectoris in women has often been considered a “soft”d iagnosis, with less-severe prognostic implications than in men, but large-scal e population studies are lacking. Objective: To determine sex differences in the incidence and prognosis of stable angina in a large ambulatory population. Desi gn: Prospective cohort study using linked national registers. Setting: All munic ipal primary health care centers, hospital outpatient clinics, occupational heal th care services, and the private sector in Finland. Participants: Among ambulat ory patients aged 45 to 89 years who had no history of coronary disease, we defi ned new cases of “nitrate angina”based on nitrate prescription(56 441 women an d 34 885 men) or “test-positive angina”based on abnormal invasive or noninvas ive test results(11 391 women and 15 806 men). Potentially eligible patients wer e evaluated between January 1, 1996, and December 31, 1998. Follow-up ended in December 2001. Main Outcome Measures: Coronary mortality at 4 years(n=7906 death s) and fatal and nonfatal myocardial infarction at 1 year(n=3129 events). Results: The age-standardized annual incidence per 100 population of all cases of ang ina was 2.03 in men and 1.89 in women, with a sex ratio of 1.07(95%confidence i nterval[CI], 1.06-1.09). At every age, nitrate angina in women and men was asso ciated with a similar increase in risk of coronary mortality relative to the gen eral population. Women with test-positive angina who were younger than 75 years had higher coronary-standardized mortality ratios than men; for example, among those aged 55 to 64 years, it was 4.69(95%CI, 3.60-6.11) in women compared wi th 2.40(95%CI, 2.11-2.73) in men(P< .001 for interaction). There was a strong, graded relationship between amount of nitrates used and event rates; women usin g higher doses of nitrates had prognoses comparable with those of men. Among pat ients with diabetes and test-positive angina, age-standardized coronary event rates were 9.9 per 100 person-years in women vs 9.3 in men(P=.69), and the full y adjusted male-female sex ratio was 1.07(95%CI, 0.81-1.41). Conclusions: Wom en have a similarly high incidence of stable angina compared with men. Furthermo re, stable angina in women is associated with increased coronary mortality relat ive to women in the general population and, among easily identifiable clinical s ubgroups, has similarly high absolute rates of prognostic outcomes compared with men.
