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At the heart of general practice since 1960

Symptoms provide early warning – predicting coronary events up to seven years in advance

Chest pain alerts to CVD risk

Chest pain can predict the risk of a coronary event as much as seven years in advance, a study of general practice concludes.

The research, the first to follow patients with chest pain prospectively in primary care, suggests it is a stronger and earlier marker of risk than had been appreciated.

Researchers raised the possibility that GPs could opportunistically screen patients for the presence of chest pain during consultations.

Dr Elaine Thomas, senior lecturer in biostatistics at Keele University, said: 'The paper shows it's a common symptom but it is quite predictive of something more important. Given [the possible consequences of heart disease], it is something to think about asking. A simple question can predict more serious symptoms.'

The study of 2,229 patients found a self-report of 'any chest pain' increased risk of a subsequent consultation for CHD by 2.3-fold in men and 1.8-fold in women.

Exertional chest pain raised risk by 3.25-fold and 3.5-fold in men and woman respectively.

The risk of a new diagnosis of CHD was significantly raised even in the seventh year after initially reporting chest pain, found the study, published in January's British Journal of General Practice.

Dr John Ashcroft, CHD lead for Erewash PCT and a GP in Ilkeston, Derbyshire, said it would need to be proven that patients identified as at risk of CHD through self-reported chest pain actually derived benefit from preventive treatment.

'This may one day be added in to that folder of information that we will put into analysis to decide whether it's worth risk-assessing patients.

'In itself it's interesting to see self-reported chest pain is something of a predictor, but it's not going to make us rush off to do something new.'

Professor Richard Hobbs, head of primary care and general practice at the school of

medicine, University of Birmingham, said: 'For anyone presenting with chest pain, particularly people with risk factors, it's going to be a differential diagnosis. But chest pain is a very common condition and per se is not a strong discriminator for individual patients.'

dcressey@cmpmedica.com

• For the latest evidence on CVD risk, go to SearchMedica.co.uk

The study – and what it found

• The first study to follow up primary care consultations for chest pain prospectively

• Total of 2,229 patients followed up for seven years

• Chest pain increased risk of CHD throughout seven-year period

• May be early manifestation of heart disease, or 'helpful marker' for other risk factors

• Asking patients about chest pain could help identify patients for preventive action

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