Prevalence of Subclinical Coronary Atherosclerosis in the General Population

Early detection of coronary artery disease (CAD) using computed tomography (CT) and calcium score (CAC) might help plan prevention strategies years in advance. This study used CT to determine the prevalence and characteristics of atherosclerosis in the general population. 

aterosclerosis coronaria subclínica

Non-contrast images were scored for CAC. After that, all images with atherosclerosis potential were assessed segment by segment. Segments were divided into: absence of atherosclerosis, 1 to 49% stenosis, and >50% stenosis.

The amazing number of 25,182 totally unaware CAD patients between 50 and 64 years of age were included.

Nearly half of them (42.1%) presented CT findings of CAD; >50% lesions was found in 5.2% of them; and left main lesions, proximal left anterior descending or 3 vessel disease were found in 1.9% of cases. And if this was not enough, 8.3% presented non-calcified plaque. 

Disease was more prevalent the older patients, and the more proximal the segments were. 

All individuals with >400 calcium score presented CAD and half of these presented significant stenosis (as expected).


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However, patients with 0 CAC showed 5.5% stenosis and 0.4% obstructive stenosis. 0 CAC in addition to increased risk of CAD lead us to 9.2% stenosis, confirmed by CT.

Conclusion

CT has shown atherosclerosis is present in nearly half of a seemingly healthy population. High CAC guarantees CAD findings, but 0 CAC offers no guarantees. 

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Original Title: Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population.

Reference: Göran Bergström et al. Circulation. 2021;144:916–929. DOI: 10.1161/CIRCULATIONAHA.121.055340.


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