About four in 10 people, ages 50-64, had subclinical coronary artery disease (CAD), and about one in 20 had serious CAD, with at least one coronary vessel having at least a 50% stenosis, a researcher reported.
Among more than 25,000 people in Sweden without heart health issues who took a screening questionnaire, and subsequently underwent coronary CT angiography (CCTA), silent CAD was common, with 42% of participants having plaque in their coronary arteries, and a higher prevalence of atherosclerosis observed in men and in older individuals, according to Goran Bergström, MD, PhD, of Sahlgrenska Academy at Gothenburg University in Sweden.
"Silent coronary artery disease is common in the general population without establish disease," he said in a presentation at the American Heart Association virtual meeting.
Bergström and colleagues developed a screening questionnaire to help identify individuals at the highest risk for CAD.
"The buildup of plaque does not cause symptoms in the early phases of atherosclerosis yet may lead to reduced blood flow to the heart and result in a heart attack," Bergström said in statement. "We investigated whether a personalized screening strategy using data easily measured at home could predict which patients are at high risk of developing heart disease."
"We were surprised that atherosclerosis was so widespread and that we could rather easily predict it with simple questions," he noted. "Our study lays the foundation for development of a home-based screening strategy to help combat cardiovascular disease."
Silent CAD can be found using the screening questionnaire, followed by a clinical visit to a healthcare center to define the risk further using [CCTA]," Bergström added.
The researchers developed two prediction models: One that could be done at home by assessing risk factors and taking waist circumference measurements. The second model, called the "clinical model," was more precise, but both models appeared to readily identify people who would benefit from further screening, Bergström said.
"We found that 30% of the people who scored the highest on the home model accounted for 67% of all the patients with disseminated [CAD] detected through CCTA," he noted.
"This is the first time this imaging technique has been used in such a large population sample," Bergström added.
The SCAPIS trial included more than 30,000 men and women with no history of prior heart attack or cardiac intervention. Participants were asked questions about gender, age, smoking, body measurements, cholesterol medication, and blood pressure.
Among the 25,182 participants screened, 10,603 individuals were determined to have some form of CAD. Of that group, 1,502 people had silent CAD with coronary artery blockages that were at least 50% stenosed, Bergström reported, adding that stenosis of that magnitude was observed in a minimum of one coronary artery in 1,072 patients.
The authors also reported that the highest frequency of plaques was seen in the proximal left anterior descending coronary artery, regardless of sex and severity of disease.
AHA discussant Pamela Douglas, MD, of Duke University in Durham, North Carolina, said, "The SCAPIS proposal to use CCTA only in those with high clinical risk requires prospective validation, including ensuring that all prognostically significant non-obstructive [CAD] is detected, so this at-risk group is not undertreated."
"Once validated prospectively, randomized clinical trials are needed to determine if the SCAPIS algorithm, cut point, and tiered approach will improve outcomes, and be cost effective compared to usual care or on as yet untested image-driven strategy," she added.
Bergström and colleagues noted that SCAPIS is an open-source project.
Disclosures
Bergstrom disclosed no relevant relationships with industry.
Douglas disclosed institutional support from industry.
Primary Source
American Heart Association
Source Reference: Bergstrom G, et al "Prevalence and prediction of subclinical coronary artery disease in the general population" AHA 2020.