Takeaway

• Asymptomatic adults with subclinical obstructive atherosclerosis of the coronary arteries on CT face higher than an 8-fold risk for myocardial infarction (MI).
• The DANE-HEART and SCOT-HEART 2 trials are now underway to evaluate computed tomography coronary angiography (CTCA)-guided primary prevention.
• In the meantime, the authors suggest considering CTCA for patients already undergoing cardiac CT and/or electrocardiogram-gated chest CT.
• The study, conducted by a Danish research team, appeared in Annals of Internal Medicine.

Why this matters

• Atherosclerosis can long precede ischemic heart disease (IHD).
• CTCA can detect asymptomatic coronary atherosclerosis.

Study design

• Prospective observational cohort of Danish adults in the longitudinal Copenhagen General Population Study (n=9533).
• Participants were aged ≥40 years without symptoms or diagnosis of IHD.
• Starting in 2010, they could opt to undergo CTCA.
• Outcome: MI.
• Funding: AP Møller og Hustru Chastine Mc-Kinney Møllers Fond.

Key results

• 46% had subclinical coronary atherosclerosis found on CTA.
• 10% had obstructive disease (narrowing of lumen >50%).
• Over a median follow-up of 3.5 years:
  • 0.7% had MI.
  • 2.7% had MI or all-cause death.
• Adjusted relative risk of MI (vs no coronary atherosclerosis):
  • With obstructive-nonextensive atherosclerosis: 8.28-fold.
  • With obstructive-extensive atherosclerosis: 12.48-fold.
• Adjusted relative risk of either MI or death was approximately 3-fold in those with extensive disease.

Limitations

• Most participants were white.
• CT results were assessed visually and were not quantitative.