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Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population

Bergström, Göran ; Persson, Margaretha LU orcid ; Adiels, Martin ; Björnson, Elias ; Bonander, Carl ; Ahlström, Håkan ; Alfredsson, Joakim ; Angerås, Oskar ; Berglund, Göran LU and Blomberg, Anders , et al. (2021) In Circulation 144(12). p.916-929
Abstract

BACKGROUND: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.

METHODS: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT... (More)

BACKGROUND: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.

METHODS: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.

RESULTS: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.

CONCLUSIONS: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Circulation
volume
144
issue
12
pages
916 - 929
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:85115941267
  • pmid:34543072
ISSN
1524-4539
DOI
10.1161/CIRCULATIONAHA.121.055340
language
English
LU publication?
yes
id
9c2c1586-0df8-495d-9562-08e6da172d0c
date added to LUP
2021-09-23 09:52:50
date last changed
2022-10-02 18:28:42
@article{9c2c1586-0df8-495d-9562-08e6da172d0c,
  abstract     = {{<p>BACKGROUND: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.</p><p>METHODS: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.</p><p>RESULTS: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score &gt;400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.</p><p>CONCLUSIONS: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.</p>}},
  author       = {{Bergström, Göran and Persson, Margaretha and Adiels, Martin and Björnson, Elias and Bonander, Carl and Ahlström, Håkan and Alfredsson, Joakim and Angerås, Oskar and Berglund, Göran and Blomberg, Anders and Brandberg, John and Börjesson, Mats and Cederlund, Kerstin and de Faire, Ulf and Duvernoy, Olov and Ekblom, Örjan and Engström, Gunnar and Engvall, Jan E and Fagman, Erika and Eriksson, Mats and Erlinge, David and Fagerberg, Björn and Flinck, Agneta and Gonçalves, Isabel and Hagström, Emil and Hjelmgren, Ola and Lind, Lars and Lindberg, Eva and Lindqvist, Per and Ljungberg, Johan and Magnusson, Martin and Mannila, Maria and Markstad, Hanna and Mohammad, Moman A and Nystrom, Fredrik H and Ostenfeld, Ellen and Persson, Anders and Rosengren, Annika and Sandström, Anette and Själander, Anders and Sköld, Magnus C and Sundström, Johan and Swahn, Eva and Söderberg, Stefan and Torén, Kjell and Östgren, Carl Johan and Jernberg, Tomas}},
  issn         = {{1524-4539}},
  language     = {{eng}},
  month        = {{09}},
  number       = {{12}},
  pages        = {{916--929}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Circulation}},
  title        = {{Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population}},
  url          = {{http://dx.doi.org/10.1161/CIRCULATIONAHA.121.055340}},
  doi          = {{10.1161/CIRCULATIONAHA.121.055340}},
  volume       = {{144}},
  year         = {{2021}},
}