Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population,Circulation

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Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
Circulation ( IF 35.5 ) Pub Date : 2021-09-20 , DOI: 10.1161/circulationaha.121.055340
Göran Bergström _{1,

2} , Margaretha Persson _{3,

4} , Martin Adiels ₅ , Elias Björnson ₁ , Carl Bonander ₅ , Håkan Ahlström ₆ , Joakim Alfredsson _{7,

8} , Oskar Angerås _{1,

9} , Göran Berglund ₃ , Anders Blomberg ₁₀ , John Brandberg _{11,

12} , Mats Börjesson _{13,

14,

15} , Kerstin Cederlund ₁₆ , Ulf de Faire ₁₇ , Olov Duvernoy ₆ , Örjan Ekblom ₁₈ , Gunnar Engström ₃ , Jan E Engvall _{8,

19,

20} , Erika Fagman _{11,

12} , Mats Eriksson ₂₁ , David Erlinge ₂₂ , Björn Fagerberg _{1,

15} , Agneta Flinck _{11,

12} , Isabel Gonçalves ₂₃ , Emil Hagström _{24,

25} , Ola Hjelmgren _{1,

2} , Lars Lind ₂₆ , Eva Lindberg ₂₇ , Per Lindqvist ₂₈ , Johan Ljungberg ₁₀ , Martin Magnusson _{3,

29,

30,

31} , Maria Mannila ₃₂ , Hanna Markstad _{33,

34} , Moman A Mohammad ₂₂ , Fredrik H Nystrom ₈ , Ellen Ostenfeld ₃₅ , Anders Persson _{8,

20,

36} , Annika Rosengren _{1,

15} , Anette Sandström ₁₀ , Anders Själander ₁₀ , Magnus C Sköld _{37,

38} , Johan Sundström _{26,

39} , Eva Swahn _{7,

8} , Stefan Söderberg ₁₀ , Kjell Torén _{15,

40} , Carl Johan Östgren _{8,

20} , Tomas Jernberg ₄₁

Affiliation

Department of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden.
Departments of Clinical Physiology (G. Bergström, O.H.), Region Västra Götaland, Gothenburg, Sweden.
Department of Clinical Sciences (M.P., G. Berglund, G.E., M. Magnusson), Lund University, Malmö, Sweden.
Departments of Internal Medicine (M.P.), Skåne University Hospital, Malmö, Sweden.
Sahlgrenska Academy, and School of Public Health and Community Medicine, Institute of Medicine (M.A., C.B.), University of Gothenburg, Sweden.
Section of Radiology, Department of Surgical Sciences (H.A., O.D.), Uppsala University, Sweden.
Departments of Cardiology (J.A., E.S.), Linköping University, Sweden.
Health, Medicine and Caring Sciences (J.A., E.S., J.E.E., F.H.N., C.J.Ö., A.P.), Linköping University, Sweden.
Cardiology (O.A.), Region Västra Götaland, Gothenburg, Sweden.
Department of Public Health and Clinical Medicine, Medicine and Heart Centre (A.B., J.L., A. Sandström, A. Själander, S.S.), Umeå University, Sweden.
Department of Radiology, Institute of Clinical Sciences (J.B., E.F., A.F.), University of Gothenburg, Sweden.
Radiology (J.B., E.F., A.F.), Region Västra Götaland, Gothenburg, Sweden.
Institute of Medicine (M.B.), University of Gothenburg, Sweden.
Center for Health and Performance (M.B.), University of Gothenburg, Sweden.
Sahlgrenska University Hospital (M.B., B.F., A.R., K.T.), Region Västra Götaland, Gothenburg, Sweden.
Department of Clinical Science, Intervention and Technology (K.C.), Karolinska Institutet, Stockholm, Sweden.
Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine (U.d.F.), Karolinska Institutet, Stockholm, Sweden.
Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden (Ö.E.).
Clinical Physiology (J.E.E.), Linköping University, Sweden.
CMIV, Centre of Medical Image Science and Visualization (J.E.E., A.P., C.J.Ö.), Linköping University, Sweden.
Department of Endocrinology, Metabolism & Diabetes and Clinical Research Center, Karolinska University Hospital Huddinge, Stockholm, Sweden (M.E.).
Department of Clinical Sciences Lund, Cardiology, Lund University and Skåne University Hospital, Lund, Sweden (D.E., M.A.M.).
Department of Clinical Sciences Malmö (I.G.), Lund University and Skåne University Hospital, Lund, Sweden.
Cardiology (E.H.), Uppsala University, Sweden.
Department of Medical Sciences, and Uppsala Clinical Research Center (E.H.), Uppsala University, Sweden.
Clinical Epidemiology (L.L., J.S.), Uppsala University, Sweden.
Respiratory, Allergy and Sleep Research (E.L.), Uppsala University, Sweden.
Department of Surgical and Perioperative Sciences (P.L.), Umeå University, Sweden.
Cardiology (M. Magnusson), Skåne University Hospital, Malmö, Sweden.
Wallenberg Center for Molecular Medicine, Lund University, Sweden (M. Magnusson).
North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa (M. Magnusson).
Heart and Vascular Theme, Department of Cardiology, and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden (M. Mannila).
Experimental Cardiovascular Research, Clinical Research Center, Clinical Sciences Malmö (H.M.), Lund University, Malmö, Sweden.
Center for Medical Imaging and Physiology (H.M.), Lund University and Skåne University Hospital, Lund, Sweden.
Department of Clinical Sciences Lund, Clinical Physiology (E.O.), Lund University and Skåne University Hospital, Lund, Sweden.
Radiology (A.P.), Linköping University, Sweden.
Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine (M.C.S.), Karolinska Institutet, Stockholm, Sweden.
Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden (M.C.S.).
The George Institute for Global Health, University of New South Wales, Sydney, Australia (J.S.).
Occupational and Environmental Medicine/School of Public Health and Community Medicine (K.T.), University of Gothenburg, Sweden.
Department of Clinical Sciences, Danderyd University Hospital (T.J.), Karolinska Institutet, Stockholm, Sweden.

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.

中文翻译：

一般人群中亚临床冠状动脉粥样硬化的患病率

背景：除了冠状动脉钙化 (CAC) 评分外，使用冠状动脉计算机断层扫描血管造影 (CCTA) 及早发现冠状动脉粥样硬化可能有助于制定预防策略。我们使用 CCTA 来确定一般人群中冠状动脉粥样硬化的患病率、严重程度和特征及其与 CAC 评分的关联。方法：我们招募了 30 154 名随机邀请的 50 至 64 岁个体参加 SCAPIS（瑞典心肺生物影像研究）。该研究包括没有已知冠心病（即，既往没有心肌梗塞或心脏手术）且使用专用双源 CT 扫描仪进行 CCTA 和 CAC 成像的高质量结果的个体。非对比图像对 CAC 进行评分。目视读取 CCTA 图像并对每段冠状动脉粥样硬化进行评分（定义为无动脉粥样硬化、1% 至 49% 狭窄或≥50% 狭窄）。使用参与加权的逆概率和瑞典注册数据评估患病率估计的外部有效性。结果：总共包括 25 182 名无已知冠心病的个体（50.6% 为女性）。42.1% 的 CCTA 检测到动脉粥样硬化；5.2% 的任何显着狭窄（≥50%）；左主干、左前降支近端或 1.9% 的 3 支血管病变；8.3% 的人群中存在任何非钙化斑块。女性动脉粥样硬化的发病平均延迟了 10 年。动脉粥样硬化在老年人中更为普遍，主要见于左前降支近端。CCTA 检测到的动脉粥样硬化的患病率随着 CAC 评分的增加而增加。在 CAC 评分 >400 的患者中，全部有动脉粥样硬化，45.7% 有明显狭窄。在 CAC 为 0 的患者中，5.5% 有动脉粥样硬化，0.4% 有明显狭窄。根据汇总队列方程，在 CAC 为 0 且 10 年动脉粥样硬化心血管疾病中等风险的参与者中，9.2% 的参与者患有 CCTA 验证的动脉粥样硬化。患病率估计具有出色的外部有效性，并且在根据年龄匹配的瑞典背景人群进行调整时变化很小。结论：在没有确诊疾病的普通人群的大型随机样本中使用 CCTA，我们发现无症状冠状动脉粥样硬化在该人群中很常见。高 CAC 分数表示严重狭窄的可能性很大，

更新日期：2021-09-21

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