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Bergström G, Persson M, Adiels M, et al. Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population. Circulation. 2021;144(12):916-929doi: 10.1161/CIRCULATIONAHA.121.055340.
Bergström, G., Persson, M., Adiels, M., Björnson, E., Bonander, C., Ahlström, H., Alfredsson, J., Angerås, O., Berglund, G., Blomberg, A., Brandberg, J., Börjesson, M., Cederlund, K., de Faire, U., Duvernoy, O., Ekblom, �. �., Engström, G., Engvall, J. E., Fagman, E., Eriksson, M., Erlinge, D., Fagerberg, B., Flinck, A., Gonçalves, I., Hagström, E., Hjelmgren, O., Lind, L., Lindberg, E., Lindqvist, P., Ljungberg, J., Magnusson, M., Mannila, M., Markstad, H., Mohammad, M. A., Nystrom, F. H., Ostenfeld, E., Persson, A., Rosengren, A., Sandström, A., Själander, A., Sköld, M. C., Sundström, J., Swahn, E., Söderberg, S., Torén, K., Östgren, C. J., & Jernberg, T. (2021). Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population. Circulation, 144(12), 916-929. https://doi.org/10.1161/CIRCULATIONAHA.121.055340
Bergström, Göran, et al. "Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population." Circulation vol. 144,12 (2021): 916-929. doi: https://doi.org/10.1161/CIRCULATIONAHA.121.055340
Bergström G, Persson M, Adiels M, Björnson E, Bonander C, Ahlström H, Alfredsson J, Angerås O, Berglund G, Blomberg A, Brandberg J, Börjesson M, Cederlund K, de Faire U, Duvernoy O, Ekblom Ö, Engström G, Engvall JE, Fagman E, Eriksson M, Erlinge D, Fagerberg B, Flinck A, Gonçalves I, Hagström E, Hjelmgren O, Lind L, Lindberg E, Lindqvist P, Ljungberg J, Magnusson M, Mannila M, Markstad H, Mohammad MA, Nystrom FH, Ostenfeld E, Persson A, Rosengren A, Sandström A, Själander A, Sköld MC, Sundström J, Swahn E, Söderberg S, Torén K, Östgren CJ, Jernberg T. Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population. Circulation. 2021 Sep 21;144(12):916-929. doi: 10.1161/CIRCULATIONAHA.121.055340. Epub 2021 Sep 20. PMID: 34543072; PMCID: PMC8448414.
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Circulation. 2021 Sep 21;144(12):916-929. doi: 10.1161/CIRCULATIONAHA.121.055340. Epub 2021 Sep 20.

Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population.

Circulation

Göran Bergström, Margaretha Persson, Martin Adiels, Elias Björnson, Carl Bonander, Håkan Ahlström, Joakim Alfredsson, Oskar Angerås, Göran Berglund, Anders Blomberg, John Brandberg, Mats Börjesson, Kerstin Cederlund, Ulf de Faire, Olov Duvernoy, Örjan Ekblom, Gunnar Engström, Jan E Engvall, Erika Fagman, Mats Eriksson, David Erlinge, Björn Fagerberg, Agneta Flinck, Isabel Gonçalves, Emil Hagström, Ola Hjelmgren, Lars Lind, Eva Lindberg, Per Lindqvist, Johan Ljungberg, Martin Magnusson, Maria Mannila, Hanna Markstad, Moman A Mohammad, Fredrik H Nystrom, Ellen Ostenfeld, Anders Persson, Annika Rosengren, Anette Sandström, Anders Själander, Magnus C Sköld, Johan Sundström, Eva Swahn, Stefan Söderberg, Kjell Torén, Carl Johan Östgren, Tomas Jernberg

Affiliations

  1. Department of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden.
  2. Departments of Clinical Physiology (G. Bergström, O.H.), Region Västra Götaland, Gothenburg, Sweden.
  3. Department of Clinical Sciences (M.P., G. Berglund, G.E., M. Magnusson), Lund University, Malmö, Sweden.
  4. Departments of Internal Medicine (M.P.), Skåne University Hospital, Malmö, Sweden.
  5. Sahlgrenska Academy, and School of Public Health and Community Medicine, Institute of Medicine (M.A., C.B.), University of Gothenburg, Sweden.
  6. Section of Radiology, Department of Surgical Sciences (H.A., O.D.), Uppsala University, Sweden.
  7. Departments of Cardiology (J.A., E.S.), Linköping University, Sweden.
  8. Health, Medicine and Caring Sciences (J.A., E.S., J.E.E., F.H.N., C.J.Ö., A.P.), Linköping University, Sweden.
  9. Cardiology (O.A.), Region Västra Götaland, Gothenburg, Sweden.
  10. Department of Public Health and Clinical Medicine, Medicine and Heart Centre (A.B., J.L., A. Sandström, A. Själander, S.S.), Umeå University, Sweden.
  11. Department of Radiology, Institute of Clinical Sciences (J.B., E.F., A.F.), University of Gothenburg, Sweden.
  12. Radiology (J.B., E.F., A.F.), Region Västra Götaland, Gothenburg, Sweden.
  13. Institute of Medicine (M.B.), University of Gothenburg, Sweden.
  14. Center for Health and Performance (M.B.), University of Gothenburg, Sweden.
  15. Sahlgrenska University Hospital (M.B., B.F., A.R., K.T.), Region Västra Götaland, Gothenburg, Sweden.
  16. Department of Clinical Science, Intervention and Technology (K.C.), Karolinska Institutet, Stockholm, Sweden.
  17. Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine (U.d.F.), Karolinska Institutet, Stockholm, Sweden.
  18. Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden (Ö.E.).
  19. Clinical Physiology (J.E.E.), Linköping University, Sweden.
  20. CMIV, Centre of Medical Image Science and Visualization (J.E.E., A.P., C.J.Ö.), Linköping University, Sweden.
  21. Department of Endocrinology, Metabolism & Diabetes and Clinical Research Center, Karolinska University Hospital Huddinge, Stockholm, Sweden (M.E.).
  22. Department of Clinical Sciences Lund, Cardiology, Lund University and Skåne University Hospital, Lund, Sweden (D.E., M.A.M.).
  23. Department of Clinical Sciences Malmö (I.G.), Lund University and Skåne University Hospital, Lund, Sweden.
  24. Cardiology (E.H.), Uppsala University, Sweden.
  25. Department of Medical Sciences, and Uppsala Clinical Research Center (E.H.), Uppsala University, Sweden.
  26. Clinical Epidemiology (L.L., J.S.), Uppsala University, Sweden.
  27. Respiratory, Allergy and Sleep Research (E.L.), Uppsala University, Sweden.
  28. Department of Surgical and Perioperative Sciences (P.L.), Umeå University, Sweden.
  29. Cardiology (M. Magnusson), Skåne University Hospital, Malmö, Sweden.
  30. Wallenberg Center for Molecular Medicine, Lund University, Sweden (M. Magnusson).
  31. North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa (M. Magnusson).
  32. Heart and Vascular Theme, Department of Cardiology, and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden (M. Mannila).
  33. Experimental Cardiovascular Research, Clinical Research Center, Clinical Sciences Malmö (H.M.), Lund University, Malmö, Sweden.
  34. Center for Medical Imaging and Physiology (H.M.), Lund University and Skåne University Hospital, Lund, Sweden.
  35. Department of Clinical Sciences Lund, Clinical Physiology (E.O.), Lund University and Skåne University Hospital, Lund, Sweden.
  36. Radiology (A.P.), Linköping University, Sweden.
  37. Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine (M.C.S.), Karolinska Institutet, Stockholm, Sweden.
  38. Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden (M.C.S.).
  39. The George Institute for Global Health, University of New South Wales, Sydney, Australia (J.S.).
  40. Occupational and Environmental Medicine/School of Public Health and Community Medicine (K.T.), University of Gothenburg, Sweden.
  41. Department of Clinical Sciences, Danderyd University Hospital (T.J.), Karolinska Institutet, Stockholm, Sweden.

PMID: 34543072 PMCID: PMC8448414 DOI: 10.1161/CIRCULATIONAHA.121.055340

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.

Keywords: coronary angiography; coronary artery disease; epidemiology; plaque, atherosclerotic; primary prevention; tomography

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