Four in 10 middle-aged individuals without a history of heart disease have silent coronary atherosclerosis and 1 in 20 have significant stenosis on coronary CT angiography (CCTA), Swedish researchers report.
"What's important is that we actually looked at the atherosclerosis of the vessel wall with angiography and now have data on the extent and the severity of atherosclerosis in the general population," lead author Göran Bergström, MD, PhD, University of Gothenburg, Sweden, told theheart.org | Medscape Cardiology.
This baseline population-level information is a prerequisite for developing successful screening strategies in high-risk individuals, he said. Recent US guidelines suggest that a coronary artery calcium (CAC) score can be used to improve classification of adults at intermediate risk based on the pooled cohort equation (PCE), with a CAC score of 0 indicating lower risk and not favoring statin therapy.
CAC testing, however, doesn't provide information on the degree of stenosis or the presence of noncalcified plaques, he noted. Significant atherosclerosis is also possible in the absence of CAC.
Indeed, among the 60% of participants with a 0 CAC score, 5.5% (4.3% of women and 7.3% of men) had CCTA-verified atherosclerosis, according to the study, published September 21 in the journal Circulation.
Defining the true prevalence of atherosclerosis in the general population is an essential first step to guide future prevention strategies, but prior estimates have been based on post-mortem evidence or small, selected populations or relied on CAC, Kuan Ken Lee, MBChB, University of Edinburgh, Scotland, and colleagues observe in an
