Asymptomatic, CT Angiography-Detected CAD Linked to 8-Fold Higher Heart Attack Risk

The biological process of coronary atherosclerosis is responsible for the onset of myocardial infarction, which together comprise the clinical syndrome known as "ischemic heart disease." Subclinical coronary atherosclerosis precedes ischemic heart disease and may develop at a young age, many years prior to the onset of clinical disease. For over five decades, obstructive coronary artery disease has been considered a significant risk factor, characterized by a luminal coronary stenosis of 50% or more. In recent years, however, the extent of atherosclerosis in the coronary tree, as well as specific morphologic characteristics of the atherosclerotic plaque, have been recognized as crucial risk factors.

A study conducted by researchers from the University of Copenhagen (Copenhagen, Denmark) on a cohort of over 9,000 individuals has found that subclinical, obstructive coronary atherosclerosis is linked to more than an eight-fold increased risk of myocardial infarction in asymptomatic middle-aged individuals without any known cardiovascular disease. The study's researchers examined 9,533 asymptomatic individuals aged 40 years or older with no previous history of cardiovascular disease to identify subclinical coronary atherosclerosis characteristics associated with myocardial infarction development. Computed tomography angiography (CTA) was used to diagnose obstructive coronary atherosclerosis in the participants.

The study revealed that 54% of individuals did not have any subclinical coronary atherosclerosis, while 46% did. Of those diagnosed with subclinical coronary atherosclerosis, 36% had non-obstructive disease and 10% had obstructive disease. Additionally, among those diagnosed with the condition, 61% of males and 36% of females had subclinical coronary atherosclerosis. The researchers concluded that identifying luminal obstructive or extensive subclinical coronary atherosclerosis could offer valuable risk assessment in patients without suspected or known ischemic heart disease who are undergoing cardiac CT and/or electrocardiogram-gated chest CT for other clinical reasons.

The team believes that their research presents an opportunity to study the contemporary natural history of coronary artery disease without any intervention, where both patients and clinicians are unaware of the scan results. The research also provides crucial insights into the rate of events and prevalence of asymptomatic coronary artery disease, which can help healthcare professionals develop targeted preventative therapies and implement effective public health prevention strategies by screening individuals with an underlying risk of coronary artery disease.

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