Do Asymptomatic Individuals Have High Prevalence of Coronary Plaque?

There is a “substantial prevalence” of subclinical coronary atherosclerotic plaque in asymptomatic individuals, according to results of the Miami Heart Study published Aug. 17 in JACC: Cardiovascular Imaging.

Khurram Nasir, MBBS, FACC, et at., conducted a cross-sectional analysis of the Miami Heart Study – an ongoing community-based, prospective cohort study at Baptist Health South Florida. A total of 2,359 patients were included in the cohort. All participants were volunteers from the Greater Miami Area with a mean age of 53 years, 50% women, 47% Hispanic/Latino, 43% non-Hispanic (White, Black, Asian, Other).

Results showed that 58% of participants had coronary artery calcium (CAC) scores = 0, 28% had CAC>0 to <100, and 13% had CAC≥100. A total of 49% of participants had plaque on the coronary computed tomography angiography (CCTA), including 16% among those with CAC=0. Overall, 6% of participants had coronary stenosis ≥50% (12% among those with coronary plaque), 1.8% had stenosis ≥70% (3.7% among those with plaque), and 7% had at least one coronary plaque with ≥1 high-risk feature (13.8% among those with plaque). Additionally, within the cohort, independent coronary plaque and high-risk predictors were seen most in older men with tobacco use, diabetes, overweight and obesity.

The authors note this is the first large study in the U.S. to evaluate the presence, type, extent and severity of coronary plaque in an asymptomatic cohort from the general population and that their “findings have important implications for understanding the epidemiology and determinants of coronary atherosclerosis in young- to middle-aged adults, and may inform public health policies and patient-level risk assessment strategies in primary prevention.”

In an accompanying editorial comment, Todd C. Villines, MD, FACC, and Nisha Hosadurg, MBBS, note that “the results of this important study, documenting the high burden of subclinical [atherosclerotic cardiovascular disease] in a very-low-risk U.S. population, serve to challenge prevention strategies primarily guided by population-derived probabilistic risk scores” and that CT-guided prevention, using CAC and potentially CCTA may provide the optimal approach to personalized cardiovascular prevention care.

Clinical Topics: Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Computed Tomography, Nuclear Imaging

Keywords: Obesity, Diabetes Mellitus, Volunteers, Tobacco Use, Health Policy, Primary Prevention, Risk Assessment, Risk Factors, Coronary Stenosis, Protestantism, Protestantism, Overweight, Consensus, Cardiovascular Diseases, Prevalence, Prospective Studies, Computed Tomography Angiography, Cross-Sectional Studies, Calcium, Plaque, Atherosclerotic, Coronary Artery Disease

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