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If you've been told you have angina, you might feel anxious about your future and worry that you could have a heart attack.

The good news is that, with treatment, many people with angina can live for a long time.¹ And making some changes in the way you live, such as stopping smoking and eating sensibly, can also help you live longer and in good health. For more, see What you can do to help yourself.

The bad news is that having angina probably means that you have coronary artery disease. With this disease, the arteries that carry blood to your heart are narrowed, so less blood can get through. If an artery gets badly blocked, you can have a heart attack. Having angina means you are more likely to die early from a heart attack.²

One study looked at men ages 42 to 65 who had recently been diagnosed with angina but who had not had a heart attack.³ Here's what it showed.

• Five years later, nearly 90 percent of the men with angina were alive. This compared with 96 percent of men who didn't have signs of coronary artery disease.
• Ten years later, slightly more than 70 percent of the men with angina were alive. This compared with slightly more than 90 percent of the men who didn't have signs of coronary artery disease.

Getting a diagnosis of angina at least gives you some warning that you have coronary artery disease, so that you and your doctor can do something about it. Only a third of people with the disease get this warning.⁴ A third die suddenly (from a condition called sudden cardiac death). And a third get a heart attack without any warning.

The outlook for you depends on many things, including how badly your arteries are narrowed. For example, the outlook is good if you don't need surgery. On average, each year only 1 percent to 2 percent of people with heart problems, such as angina, who don't need surgery die from a heart attack, and a further 2 percent to 3 percent have a heart attack but get better.^{5 6 7 8}

But some people with angina are more likely to have a heart attack. Here are some things that can increase your risk of having one.

• You are a man.⁹
• You get angina without much exercise.
• You have an abnormal electrocardiogram (ECG for short) while you are resting.¹⁰ About half of people with stable angina have this.¹¹ For more on ECGs, see Tests for angina.
• You have had a heart attack in the past.²
• Your heart isn't pumping well, especially on the left side. In this case, you might also get breathless very easily and have heart failure.¹²
• A stress test shows that you get angina without much exercise. About one-third of people with stable angina who are sent to the hospital have this.¹² For more on stress tests, see Tests for angina.
• You have narrowing of the main coronary artery going to the left side of your heart. Or you have narrowing of all of your coronary arteries.^{4 12}
• You have other factors that make your risk higher, such as smoking, high blood pressure, diabetes or high cholesterol.^{13 14 15}
• Your angina is getting worse or the pattern is changing.¹⁶

If you're at higher risk for a heart attack, you need to find out early so that you can get the best treatment right away.

You might worry about doing your usual activities or enjoying life as normal. The good news is that with the right treatment, many people with angina can keep doing the things they enjoy.

Having angina can affect certain kinds of work. For example, you might no longer be able to do a job that involves running heavy machinery or driving certain kinds of vehicles. Ask your doctor about this.

You should still be able to drive, as long as your angina is under control. Ask your doctor if you have to tell your state's department of motor vehicles (DMV) and your car insurance company.

You might worry that having sex will bring on your angina. But most people can still enjoy sex.

If you're taking medications called nitrates, you shouldn't take certain drugs for erection problems. Some of these drugs (with brand names) are listed below.

• sildenafil (Viagra)
• tadalafil (Cialis)
• vardenafil (Levitra)

Nitrates can lower your blood pressure, and these other drugs can lower it even more. That can be dangerous.

If you worry about having sex, talk to your doctor. You might feel embarrassed about bringing this up. But sex is a normal part of life. Your doctor is used to dealing with sexual problems. He or she may be able to help you and your partner.

If your doctor has any doubts, he or she might suggest a stress test to see how much exercise is safe for you. For more, see Tests for angina.

You might wonder if it's safe for you to travel by airplane. Generally, if you can climb 12 stairs and walk about 55 yards on flat ground without getting very breathless and without getting angina, you can fly as a passenger.¹⁷

Having angina can affect how much you get out of life. You might worry so much about your condition that you feel you have to take it easy and can't live life normally.¹⁸

You might think of an angina attack as a sort of mini heart attack (it isn't). This might make you feel as though you have to stop doing things you enjoy.¹⁹ And this can give you more anxiety and even depression.

If you're worried or feeling down, talk to your doctor about a self-help angina plan. This plan is based on a workbook and a relaxation tape. If you have newly diagnosed angina, the plan can help you feel better and have less anxiety and depression. You work with a nurse who helps you change the way you live and advises you about medication.²⁰

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.