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Severe-Extensive Coronary Atherosclerosis in Low-Risk Individuals and Absence of Coronary Atherosclerosis in High-Risk Individuals : The SCAPIS Extremes Project

Johansson, Madeleine LU orcid ; Bergström, Göran ; Jernberg, Tomas ; Hagström, Emil LU ; Söderberg, Stefan ; Östgren, Carl Johan LU ; Engström, Gunnar LU ; Gottsäter, Anders LU and Nilsson, Peter M LU (2025) In European Journal of Preventive Cardiology
Abstract

AIM: Factors associated with unexpected absence or presence of coronary atherosclerosis in individuals at high/low estimated cardiovascular (CV) risk are largely unexplored. We assessed two extreme phenotypes: 1) no coronary atherosclerosis despite very high CV risk; and 2) severe-extensive coronary atherosclerosis despite low CV risk.

METHODS: A multicenter, cross-sectional nationwide, population-based cohort of 30,154 randomly invited individuals (age 50-64 years; 51% women). Coronary plaque burden was assessed by coronary computed tomography angiography using coronary artery calcium score and segment involvement score. CVD risk was estimated by the Systematic Coronary Risk Evaluation (SCORE2) and SCORE2-Diabetes, as... (More)

AIM: Factors associated with unexpected absence or presence of coronary atherosclerosis in individuals at high/low estimated cardiovascular (CV) risk are largely unexplored. We assessed two extreme phenotypes: 1) no coronary atherosclerosis despite very high CV risk; and 2) severe-extensive coronary atherosclerosis despite low CV risk.

METHODS: A multicenter, cross-sectional nationwide, population-based cohort of 30,154 randomly invited individuals (age 50-64 years; 51% women). Coronary plaque burden was assessed by coronary computed tomography angiography using coronary artery calcium score and segment involvement score. CVD risk was estimated by the Systematic Coronary Risk Evaluation (SCORE2) and SCORE2-Diabetes, as appropriate.

RESULTS: In total 10,628 individuals without and 189 with diabetes were eligible. Absence of coronary plaques despite high SCORE2-risk occurred in 1.2% non-diabetic and 14.0% diabetic subjects. Severe-extreme coronary plaques despite low SCORE2-risk occurred in 0.7% non-diabetic and 0.3% diabetic subjects. In non-diabetic subjects, severe-extensive coronary plaque burden despite low SCORE2-risk was more likely in men, with increasing age, more pack-years of smoking, previous smoking, hypertension, hyperlipidemia, family history of CVD, and higher systolic blood pressure (all p<0.002). A similar but reverse pattern was observed among subjects without coronary plaques despite high SCORE2-risk. In addition, diabetic subjects without coronary plaques and high SCORE2-risk demonstrated a higher likelihood of moderate physical activity, higher education levels, and lower body mass index (p<0.05).

CONCLUSION: SCORE2-risk correlated well with presence of coronary atherosclerosis, yet 1.9% non-diabetic subjects and 14.3% diabetic subjects display extreme coronary phenotypes with a mismatch between estimated cardiovascular risk and signs of coronary atherosclerosis.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
European Journal of Preventive Cardiology
publisher
Oxford University Press
external identifiers
  • pmid:40644405
ISSN
2047-4881
DOI
10.1093/eurjpc/zwaf424
project
Vascular Ageing and Arterial Stiffness in the Swedish Population
language
English
LU publication?
yes
additional info
© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.
id
8c871e5d-bc90-4d75-a7ae-0c8a7a187e1d
date added to LUP
2025-07-20 13:31:40
date last changed
2025-07-21 12:44:30
@article{8c871e5d-bc90-4d75-a7ae-0c8a7a187e1d,
  abstract     = {{<p>AIM: Factors associated with unexpected absence or presence of coronary atherosclerosis in individuals at high/low estimated cardiovascular (CV) risk are largely unexplored. We assessed two extreme phenotypes: 1) no coronary atherosclerosis despite very high CV risk; and 2) severe-extensive coronary atherosclerosis despite low CV risk.</p><p>METHODS: A multicenter, cross-sectional nationwide, population-based cohort of 30,154 randomly invited individuals (age 50-64 years; 51% women). Coronary plaque burden was assessed by coronary computed tomography angiography using coronary artery calcium score and segment involvement score. CVD risk was estimated by the Systematic Coronary Risk Evaluation (SCORE2) and SCORE2-Diabetes, as appropriate.</p><p>RESULTS: In total 10,628 individuals without and 189 with diabetes were eligible. Absence of coronary plaques despite high SCORE2-risk occurred in 1.2% non-diabetic and 14.0% diabetic subjects. Severe-extreme coronary plaques despite low SCORE2-risk occurred in 0.7% non-diabetic and 0.3% diabetic subjects. In non-diabetic subjects, severe-extensive coronary plaque burden despite low SCORE2-risk was more likely in men, with increasing age, more pack-years of smoking, previous smoking, hypertension, hyperlipidemia, family history of CVD, and higher systolic blood pressure (all p&lt;0.002). A similar but reverse pattern was observed among subjects without coronary plaques despite high SCORE2-risk. In addition, diabetic subjects without coronary plaques and high SCORE2-risk demonstrated a higher likelihood of moderate physical activity, higher education levels, and lower body mass index (p&lt;0.05).</p><p>CONCLUSION: SCORE2-risk correlated well with presence of coronary atherosclerosis, yet 1.9% non-diabetic subjects and 14.3% diabetic subjects display extreme coronary phenotypes with a mismatch between estimated cardiovascular risk and signs of coronary atherosclerosis.</p>}},
  author       = {{Johansson, Madeleine and Bergström, Göran and Jernberg, Tomas and Hagström, Emil and Söderberg, Stefan and Östgren, Carl Johan and Engström, Gunnar and Gottsäter, Anders and Nilsson, Peter M}},
  issn         = {{2047-4881}},
  language     = {{eng}},
  month        = {{07}},
  publisher    = {{Oxford University Press}},
  series       = {{European Journal of Preventive Cardiology}},
  title        = {{Severe-Extensive Coronary Atherosclerosis in Low-Risk Individuals and Absence of Coronary Atherosclerosis in High-Risk Individuals : The SCAPIS Extremes Project}},
  url          = {{http://dx.doi.org/10.1093/eurjpc/zwaf424}},
  doi          = {{10.1093/eurjpc/zwaf424}},
  year         = {{2025}},
}