Obstructive subclinical coronary atherosclerosis powerfully predicts heart attack risk

Obstructive subclinical coronary atherosclerosis powerfully predicts heart attack risk

Jenny Blair   |   29 March 2023


  • 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.


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


Fuchs A, Kühl JT, Sigvardsen PE, Afzal S, Knudsen AD, Møller MB, de Knegt MC, Sørgaard MH, Nordestgaard BG, Køber LV, Kofoed KF. Subclinical coronary atherosclerosis and risk for myocardial infarction in a Danish cohort. Ann Int Med. 2023 Mar 28 [Epub ahead of print]. doi: 10.7326/M22-3027.