***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
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    Input: Angina pectoris is a manifestation of coronary heart disease , yet little is known from clinical or epidemiologic studies about its prognosis in older population s. We investigated the relation of uncomplicated angina symptoms to risk of coronary heart disease mortality within 3 years in a prospect i ve study of 8,359 people aged 65 and older residing in three communities . From baseline ( 1981 - 1983 ) to the third year of follow-up ( 1984 - 1986 ) , there were 245 deaths from coronary heart disease . Three classifications of chest pain were defined using the Rose Question naire : nonexertional chest pain , chest pain on exertion ( including angina ) , and angina . Exertional chest pain was a strong , independent predictor of coronary heart disease death for older men and women . There were no differences in the prognostic implication s of this symptom between the sexes ; the relative risks being 2.4 ( 95 % confidence interval , 1.4 - 4.4 ) in men and 2.7 ( 1.7 - 4.2 ) in women . The risk of coronary heart disease mortality for those reporting chest pain on exertion was at least as high as that for participants whose symptoms met the Rose Question naire criteria for angina . The association between exertional chest pain and coronary heart disease mortality was independent of other coronary risk factors . The relation was specific for deaths from coronary heart disease , as there was no association between exertional chest pain and noncoronary causes of death .  Chest pain on exertion conveys important prognostic information about risk of coronary death in older population s , regardless of gender The aim of this study was to determine the prevalence of angina and possible infa rct ( WHO cardiovascular question naire ) and electrocardiographic abnormalities ( Minnesota Coding ) in elderly Chinese subjects aged 70 + years living in Hong Kong , and the association with some cardiovascular risk factors . A sub sample of 197 subjects ( 96 men , 101 women ) selected according to geographical area from a territory-wide health survey consisting of 2032 elderly subjects selected by an age and sex stratified r and om sampling method was studied . Overall , 7 % of men and 9 % of women had symptoms suggestive of angina , while 6 % of men and 4 % of women had symptoms suggestive of possible infa rct . There were fewer symptoms in the 80 + age group . Forty-two percent of men and 35 % of women had normal electrocardiograms . The prevalence of probable ischaemic heart disease ( using the Whitehall Criteria ) was 6 % for men and 7 % for women , while the figures for possible disease were 23 % and 25 % , respectively . The percentage with abnormalities increased with age . The prevalence of coronary heart disease defined by the presence of symptoms , a history of known disease plus use of medication , and electrocardiographic abnormalities suggestive of probable disease , was 26 % for men and 27 % for women . These findings were comparable with studies in elderly Caucasian population s. Only a higher socioeconomic grouping and lower HDL cholesterol were identified as associated risk factors . It is concluded that the prevalence of coronary heart disease in the elderly Chinese population in Hong Kong is at least as high in Caucasian population s , and few modifiable risk factors were identified in the elderly aged 70 years and over STUDY OBJECTIVE : To establish the prevalence of main cardiovascular risk factors in the province of Gerona , where the incidence of myocardial infa rct ion is known to be low . DESIGN : This was a cross sectional study of prevalence of cardiovascular risk factors conducted on a large r and om population sample . SETTING : The province of Gerona , Spain . PARTICIPANTS : Two thous and four hundred and four eligible inhabitants of Gerona aged between 25 and 74 years were r and omly selected for a multi-stage sample stratified by age and sex . The following were st and ardly measured : lipids ( total cholesterol , high density , low density , lipoprotein ( a ) and triglycerides ) , fibrinogen , basal glycaemia , arterial pressure , anthropometric variables , smoking , history of angina ( Rose question naire ) , and a medical history question naire . Population measurements were st and ardised for the world population of 24 to 74 years of age . RESULTS : The participation rate was 72.7 % ( 1748 ) .  Total mean cholesterol was 5.69 mmol/l in men and 5.61 mmol/l in women and mean high density cholesterol was 1.22 mmol/l and 1.47 mmol/l , respectively . Median lipoprotein ( a ) was 0.22 g/l . These three lipids increased significantly with age . Mean fibrinogen was 2.92 g/l in men and 3.09 g/l in women , and was higher in smokers . The prevalence of hypertension ( systolic arterial tension > or = 140 mm Hg or diastolic > or = 90 mm Hg or drug treatment ) was 31.3 % in men and 27.7 % in women . The proportion of male smokers was 33.8 % and female smokers 22.7 % . The proportion of female smokers in the 25 - 34 year age group exceeded that of the remaining age groups for both men and women . CONCLUSIONS : The prevalence of cardiovascular risk factors in Gerona is relatively high for the low myocardial infa rct ion incidence typical of the area , although similar to that of other Spanish areas . The factors that confer sufficient protection to compensate for the effect of the prevalence of these risk factors remain to be eluci date Background —Although patient-reported health status measures have been used as end points in clinical trials , they are rarely used in other setting s. Demonstrating that they independently predict mortality and hospitalizations among out patients with coronary disease could emphasize their clinical value . Methods and Results —This study evaluated the prognostic utility of the Seattle Angina Question naire ( SAQ ) , a disease-specific health status measure for patients with coronary artery disease . Patients were enrolled in a prospect i ve cohort study from 6 Veterans Affairs General Internal Medicine Clinics . All patients reporting coronary artery disease who completed a SAQ and had 1 year of follow-up were analyzed ( n=5558 ) .  SAQ predictor variables were the physical limitation , angina stability , angina frequency , and quality -of-life scores . The primary outcome was 1-year all-cause mortality , and a secondary outcome was hospitalization for acute coronary syndrome ( ACS ) . Lower  SAQ scores were associated with increased risks of mortality and ACS admissions . Prognostic models controlling for demographic and clinical characteristics demonstrated significant independent mortality risk with lower SAQ physical limitation scores ; odds ratios for mild , moderate , and severe limitation were 1.5 , 2.0 , and 4.0 versus minimal limitation ( P < 0.001 ) . Odds ratios for mild , moderate , and severe angina frequency were 0.8 , 1.2 , and 1.6 ( P = 0.078 ) . The odds ratios for ACS admission among those with mild , moderate , and severe angina frequency were 1.4 , 2.0 , and 2.2 , respectively ( P = 0.016 ) . Conclusions —SAQ scores are independently associated with 1-year mortality and ACS among out patients with coronary disease and may serve a valuable role in the risk stratification of such patients The Social Insurance Institution 's Coronary Heart Disease Study is a prospect i ve population study design ed to investigate the prevalence , risk factors and incidence of coronary heart disease ( CHD ) in middle-aged Finnish men and women . The study population consisted of 5 738 men and 5 224 women , aged 30 - 59 years at entry , drawn from 12 cohorts from south-western , western , central and eastern Finl and . The cohorts consisted of whole or r and om sample s of rural or semiurban dwellers or employees of a factory . The participation rate was 90 per cent . The prevalence of symptoms was determined by the Rose question naire and abnormalities on resting ECG were coded according to the Minnesota code . Blood pressure , smoking habits , serum cholesterol , triglycerides , postload plasma glucose and obesity were the risk factors analysed at the baseline examination . The mortality of examinees has been followed continuously . This report deals with the main findings at the baseline examination and the mortality follow-up experience in 5 years . The prevalence of typical angina pectoris was 4.4 per cent in men and 5.4 per cent in women . Unequivocal ECG signs of past myocardial infa rct ion were observed in 1.0 per cent of men and 0.3 per cent of women . Other ECG findings suggesting CHD were observed in 9.2 per cent of men and 11.1 per cent of women . The 5-year mortality was 4.3 per cent in men and 0.9 per cent in women . Men with typical chest pain symptoms had a seven-fold risk to die from CHD , compared to men without symptoms . Men with ECG abnormalities compatible with an old infa rct ion had a 19.5-fold and men with other ECG findings suggesting CHD a 7.1-fold risk to die from CHD compared to men without resting ECG abnormalities . Men with ECG findings as the only indicator of CHD had worse survival than men with symptoms as the only indicator of CHD . The value of symptoms and ECG findings as predictors of CHD mortality in women was very low The prevalence of coronary heart disease was determined by a conducted survey in a r and om sample of 3689 subjects 20 years of age or older in 59 communities representing the Turkish adult population .  Interview with a question naire , physical examination of the cardiovascular system and recording of a 12-lead ECG were performed . The latter was coded according to the Minnesota code . Expressed in age-adjusted rates ( for 35 - 64 years ) , prevalence rates per 100 men were as follows : typical angina 3.7 , atypical angina 0.9 , electrocardiographic evidence of myocardial infa rct ion and /or ischemia 3.7 , any of the stated findings suggesting coronary heart disease 8 . Women had a substantially higher rate of atypical angina , positive ECG findings and of any of the stated manifestations for coronary heart disease , whereas they had a significantly lower rate of Q/QS patterns as well as of a history of myocardial infa rct ion . Based on a probability-related point score , age-adjusted clinical coronary heart disease was estimated to prevail in 5.8 % of men and 5 % of women ( P > 0.4 ) in the sample of the Turkish population . The respective rates in urban residents was 6 % and in rural resident 4.8 % . Among participants diagnosed coronary heart disease , 63 % presented the form of angina without infa rct ion , 27 % had evidence of myocardial infa rct ion , 7 % ' silent myocardial ischemia ' and 3 % cardiac failure alone BACKGROUND The Rose angina question naire has been extensively used in different cultural setting s , but may not perform consistently in different ethnic groups . We set out to assess the performance of the Rose angina question naire in UK South Asians compared with Europeans . METHODS Data on major ECG abnormalities , possible or definite Rose question naire angina and diagnosed angina were collected from an age- and sex-stratified r and om sample of 1509 adults from European , Indian , Pakistani and Bangladeshi ethnic groups . RESULTS The ECG abnormalities were commoner in South Asians than Europeans ( 6 % versus 2 % in men ) . The prevalence in both South Asian and European men of possible Rose angina and diagnosed angina was 18 % and 8 % , respectively , but definite Rose angina was less common in South Asians ( 3 % versus 6 % ) . Definite Rose angina showed lower sensitivity for other measures in South Asians than in Europeans : sensitivity for a doctor 's diagnosis was 21 % in South Asian and 37 % in European men . For possible Rose angina , the corresponding figures were 81 % and 84 % . Similar patterns were seen in women . CONCLUSIONS The performance of the Rose angina question naire was sufficiently inconsistent to warrant further work to achieve greater cross-cultural validity . Possible Rose angina performed more consistently across ethnic groups than definite Rose angina and pending further validation studies may be the most appropriate form to use A community based epidemiologival survey of coronary heart disease ( CHD ) was carried out on a r and om urban sample of 13,560 adults of different ethnic groups in Delhi . CHD was diagnosed either on the basis of clinical history , supported by documentary evidence of treatment in hospital/home or on the ECG evidence in accordance with Minnesota Code . The prevalence rate of CHD on clinical basis per 1000 adults was the highest in Sikhs ( 47.3 ) , lowest in Muslims ( 22.8 ) and identical in Hindus ( 31.8 ) and Christians ( 31.2 ) . The prevalence rate/1000 of silent CHD on the basis of ECG was high in Muslims ( 89.5 ) and Sikhs ( 87.3 ) , low in Christians ( 25.0 ) and intermediate in Hindus ( 60.0 ) . The Sikhs showed the highest prevalence rate of myocardial infa rct ( MI ) ( 15.5 ) and angina ( AP ) ( 31.8 ) compared to other communities . The prevalence rate of CHD on clinical basis was higher in males than females in all communities . The prevalence of silent CHD was higher in females in Hindus and Sikhs but in Muslims it 
    Output:
    
Over time and at different ages , independent of diagnostic and treatment practice s , women have a similar or slightly higher prevalence of angina than men across countries with widely differing myocardial infa rct ion mortality rates