Introduction Coronary heart disease (CHD) is one of the most common causes of morbidity and mortality in Iran. The aim of this cohort study is evaluating the ability of Rose questionnaire (WHO angina questionnaire) and ECG to predict 10-year CHD events in a population with high prevalence of CHD.

Methods Study population included 5652 subjects ≥30 years (3244 females), free of self reported CHD at the baseline. Subjects were categorised to four groups according to their Rose Angina and ECG status (Whitehall criteria, Minnesota codes of 1.1, 1.2, 1.3, 1.4–4.4, 5.1–5.3, 7.1 in ECG) at the baselime as Rose−/ECG−, Rose+/ECG−, Rose−/ECG+, Rose+/ECG+. RR of CHD were estimated using Cox proportional hazard model given Rose−/ECG− as the reference.

Results 387 CHD events (169 women) were observed. After age adjustment, RR was 2.66 (95% CI 1.76 to 4.01) and 2.50 (1.65 to 3.81) for Rose+/ECG− group in men and women respectively. These figures for Rose−/ECG+ were 1.63 (1.09 to 2.45) and 2.21 (1.48 to 3.29). After more adjustment for traditional risk factors, RR was 2.60 (1.72 to 3.93) and 2.28 (1.50 to 3.47) for Rose+/ECG− in men and women respectively. Regarding Rose−/ECG+ group, the multivariate RR was 1.38 (0.92 to 2.08) and 2.04 (1.37 to 3.05) for men and women, respectively.

Conclusions Rose questionnaire is a powerful and independent predictor of CHD events in Iranian men and women. Although, ECG add more information beyond the other risk factors to predict CHD in women but in men Rose questionnaire is a better predictor than ECG.