Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population

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 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.

Heart age estimated using explainable advanced electrocardiography

“…By methodological design, onlyhealthy subjectswere initially included when considering optimal measures of ECG available from 10-second 12-lead ECG for predicting the 5-minute ECG Heart Age. The 10-second ECG measures considered for the prediction model included: (1) From the conventional ECG: heart rate, R-to-R, P-wave, PR, QRS, QT, QTc, and TQ interval durations, as well as the conventional ECG amplitudes and axes; (2) From the transformation of the 12-lead ECG to the Frank X, Y and Z lead vectorcardiogram (VCG) via Kors' transform [24][25][26][27][28] : the spatial means and peaks QRS-T angles, the spatial ventricular gradient and its individual QRS and T components, the spatial QRS-and T-wave axes (azimuths and elevations), waveform amplitudes and areas, including those in the three individual vectorcardiographic planes, and spatial QRS-and T-wave velocities; and (3) measures of QRS-and T-wave waveform complexity based on singular value decomposition after signal averaging [29][30][31] .…”

Cardiac CT angiography in current practice: An American society for preventive cardiology clinical practice statement✰

“…Notably, recently completed and ongoing clinical trials may address these goals in either direct or indirect fashion. In the largest population-based study performed to date, 25,182 people aged 50–64 years underwent CCTA as part of the Swedish Cardiopulmonary Bioimage Study (SCAPIS) [175] . From this asymptomatic population, the prevalence of any CCTA-identified atherosclerosis was 42.1%, underscoring a vast epidemic of CHD for which CCTA can pinpoint individuals with obstructive and silent disease who may benefit from more aggressive medical treatment and lifestyle interventions.…”

The value of combining individual and small area sociodemographic data for assessing and handling selective participation in cohort studies: Evidence from the Swedish CardioPulmonary bioImage Study

“…However, cohort studies that rely on voluntary clinical examinations tend to be skewed towards healthy individuals with high socioeconomic status [ 3 , 4 ], and SCAPIS is no exception [ 5 , 6 ]. This type of non-random participation can pose a severe threat to the internal and external validity of study results [ 1 , 7 , 8 ].…”