Rates of heart attack and coronary death among British middle aged men have fallen steadily since the late 1970s, but this has been largely offset by an increase in the rate of diagnosed angina, finds a study in this week's BMJ.

These results emphasise the ongoing need for health service resources for angina, say the researchers.

The study involved 7,735 men, aged 40-59 in 1978-80, who were randomly selected from one general practice in 24 different British towns. The men were monitored over a 20 year period to examine trends in rates of diagnosed (medically recorded) coronary heart disease.

The rate of major coronary events fell substantially over the 20 year period by an average of 3.6% per year. In contrast, the rate of first diagnosed angina increased by an average of 2.6% per year, resulting in no apparent change in the overall incidence of diagnosed coronary heart disease.

The trend in angina may well be due to changes in diagnostic practices, rather than a real increase in disease incidence, say the authors. Nevertheless, the trend raises concerns for health service resources for angina and suspected angina.

The results also highlight the need for continued emphasis on the prevention of coronary heart disease, they conclude.

Trends in rates of different forms of diagnosed coronary heart disease, 1978 to 2000: prospective, population based study of British men BMJ Volume 330, pp 1046-9

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