Disclosures: Bergström reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
September 20, 2021
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Atherosclerosis present in more than 40% of middle-aged individuals with no prior CHD

Disclosures: Bergström reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Researchers in Sweden reported that atherosclerosis was present in more than 40% of individuals aged 50 to 64 years with no known CHD.

Additionally, a coronary artery calcium score of zero may not rule out the possibility of atherosclerosis being present, according to data published in Circulation.

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Atherosclerosis burden

“Population strategies for prevention of cardiovascular disease have been successful and likely explain the reduction in the incidence of MI in recent decades. However, MI is still a common condition, with high morbidity and a 28-day mortality of 24% in Sweden,” Göran Bergström, MD, PhD, professor and senior consultant in clinical physiology in the department of molecular and clinical medicine at the University of Gothenburg, Sweden, and colleagues wrote. “Improved strategies are needed to identify individuals at the highest risk of cardiovascular disease to complement population-based efforts.

“The aim of the current study was to determine the prevalence and burden of coronary CTA-detected coronary artery atherosclerosis and its association with CAC scores in the general population without established coronary heart disease,” the researchers wrote. “This is the first report from SCAPIS based on all 30,154 recruited participants.”

A total of 25,182 individuals aged 50 to 64 years (51% women) with no known CHD (no previous MIs or cardiac procedures) were included in the SCAPIS analysis. Coronary CT angiography and CAC imaging were performed using dedicated dual-source CT scanners. Researchers scored noncontrast images for CAC, and coronary CT angiograms were scored for atherosclerosis per segment (no atherosclerosis, 1% to 49% stenosis or 50% stenosis).

ASCVD in the general population

Researchers reported that atherosclerosis detected using coronary CTA was found in 42.1% of the overall cohort. Stenosis of 50% or more was detected in 5.2%; left main, proximal left anterior descending artery or three-vessel disease was detected in 1.9% of the cohort; and any noncalcified plaques in 8.3% of the cohort.

On average, atherosclerosis onset occurred 10 years later for women compared with men and was more prevalent among older adults.

CAC was detected in 40.2% of the population, with a median CAC score of 35.

According to the study, the prevalence of atherosclerosis increased as CAC scores increased. Among participants with a CAC score of zero, 5.5% had atherosclerosis and 0.4% had significant stenosis. Among participants with a CAC score of more than 400, all had atherosclerosis and 45.7% had significant stenosis.

Moreover, of the participants with a CAC score of zero and intermediate 10-year risk for ASCVD, 9.2% had coronary CTA-verified atherosclerosis.

“The current 2019 American Heart Association/American College of Cardiology guideline for prevention of heart attacks states that adults with a zero CAC score and intermediate level of risk factors are at low risk of future heart attack,” Bergström said in a press release. “We found that 9.2% of people who fit that description had atherosclerosis in their coronary arteries visible by coronary CTA. One strength of coronary CTA is that not-yet calcified atherosclerosis can be detected. We found that 8.3% of the adults had one or more noncalcified plaques. Noncalcified atherosclerosis is believed to be more prone to cause heart attacks compared with calcified atherosclerosis.

“It is important to know that silent coronary atherosclerosis is common among middle-aged adults, and it increases sharply with sex, age and risk factors,” Bergström said. “A high CAC score means there is a high likelihood of having obstruction of the coronary arteries. However, more importantly, a zero CAC score does not exclude adults from having atherosclerosis, especially if they have many traditional risk factors of coronary disease.”

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