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Background Despite abundant knowledge about the relationship between inflammation and coronary artery disease (CAD), it is still unknown whether high sensitivity C-reactive protein (hsCRP) is associated with coronary atherosclerosis in the general population. Objectives The project aimed to study the association between systemic inflammation, measured as hsCRP, and coronary artery atherosclerosis in a large population based cohort. Methods 30,154 randomly selected men and women aged between 50 and 64 years were included in the SCAPIS (Swedish Cardiopulmonary Bioimage Study). After excluding those not undergoing coronary computed tomography angiography (CCTA), those with proximal segments not technically assessable and those with missing values of hsCRP, 25,408 individuals were analysed. Coronary artery atherosclerosis was defined as presence of plaque of any degree (1–49% or ≥50% diameter stenosis) or segments not assessable due to calcification in any of the 18 coronary segments. Analysis of severe atherosclerosis included participants with ≥50% diameter stenosis in any of the left main coronary artery (LMCA), the proximal left anterior descending artery (LAD) or three vessel disease including ≥50% diameter stenosis in any of the segments in each of the LAD, right coronary artery (RCA) and circumflex artery (CX). Participants with hsCRP above the lowest detection limit (≥0.7mg/L) were divided into tertiles and compared with hsCRP<0.7 mg/L as a reference. Results The highest tertile of measurable hsCRP (≥2.3 mg/L) was associated with coronary atherosclerosis in a multivariate analysis adjusted for classical cardiovascular risk factors (Table 1). HsCRP was also related to atherosclerosis with significant coronary artery diameter stenosis ≥50%, ≥4 segments involved, severe atherosclerosis and atherosclerosis with noncalcified plaques. Also, moderately elevated hsCRP (1.2–2.2 mg/L) was significant associated with noncalcified plaques. In a stratified analysis, coronary atherosclerosis was associated with the two highest tertiles of hsCRP (≥1.2 mg/L) in women, but not in men. Conclusion Elevated hsCRP was associated with the prevalence of coronary atherosclerosis in a population based cohort of middle-aged men and women. The relationships were more pronounced for atherosclerosis with noncalcified plaques and in women compared to men. This suggests that more attention should be given to hsCRP in risk assessment in middle-aged individuals without known disease, especially in women. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The Swedish Heart Lung FoundationKnut and Alice Wallenberg Foundation

Background Angina pectoris (AP) is a common clinical presentation with low association to significant coronary artery disease (CAD) in selected cohorts, though yet associated with an elevated risk of major cardiovascular adverse events. Current knowledge on AP prevalence is not up to date since contemporary cross-sectional population-based studies using symptom evaluation are sparse and epidemiological studies often use administrative data from routine health care. Also, there is a lack of studies in the general population examining the association between AP and presence of coronary atherosclerosis. Purpose To assess the prevalence of AP, the relationship to CAD, and risk factors associated to the conditions in a population-based, middle-aged Swedish cohort. Methods Data were based on the Swedish CArdioPulmonary bioImage Study (SCAPIS), in which 30,154 men and women aged 50–64 years were recruited from the general population between 2013 and 2018. Exposure variables included information from blood sampling, physiological examinations, coronary computed tomographic angiography (CCTA) and an extensive questionnaire, including WHO Rose questionnaire on AP. Participants that completed the Rose questionnaire were included and categorized as having Rose angina or No angina. Subjects with a valid CCTA were further assessed regarding correlation between having Rose angina and degree of CAD, categorized as obstructive (>50% occlusion, O-CAD), non-obstructive (<50% occlusion, NO-CAD) or normal coronary angiography (Normal CA). Associations between risk factor exposures and outcomes were analysed in both cohorts using bivariate logistic regression. Results The main cohort consisted of N=28,974 individuals, of which n=1025 fulfilled the criteria of Rose angina, giving a prevalence of 3.5%. Out of these, N=24,602 subjects constituted the CCTA-cohort. Coronary atherosclerosis was significantly more common in individuals having Rose angina compared with those with No angina, (p≤0.001; O-CAD 11.8% vs 5.4%, NO-CAD 38.9% vs 37.0%, Normal CA 49.4% vs 57.7%). Factors associated with Rose angina were birthplace outside of Sweden, low educational level, unemployment, poor economic status, symptoms of depression, and high degree of general stress (Table). Physical inactivity, and current or previous cardiopulmonary diseases only marginally attenuated the associations. These findings were consistent in the sub-population of Rose angina with NO-CAD or Normal CA. Conclusion Rose Questionnaire AP was common in a Swedish general population, with a greater association to coronary atherosclerosis at CCTA compared with asymptomatic individuals. O-CAD was though uncommon. Risk factors associated with AP were sociodemographic and psychological, irrespective of degree of CAD. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): SCAPIS has been funded mainly from the Swedish Heart- and Lung foundation and Knut och Alice Wallenberg foundation.