Subclinical Coronary Atherosclerosis and Risk for Myocardial Infarction in a Danish Cohort: A Prospective Observational Cohort Study


BACKGROUND: Coronary atherosclerosis may develop at an early age and remain latent for many years.

OBJECTIVE: To define characteristics of subclinical coronary atherosclerosis associated with the development of myocardial infarction.

DESIGN: Prospective observational cohort study.

SETTING: Copenhagen General Population Study, Denmark.

PARTICIPANTS: 9533 asymptomatic persons aged 40 years or older without known ischemic heart disease.

MEASUREMENTS: Subclinical coronary atherosclerosis was assessed with coronary computed tomography angiography conducted blinded to treatment and outcomes. Coronary atherosclerosis was characterized according to luminal obstruction (nonobstructive or obstructive [≥50% luminal stenosis]) and extent (nonextensive or extensive [one third or more of the coronary tree]). The primary outcome was myocardial infarction, and the secondary outcome was a composite of death or myocardial infarction.

RESULTS: A total of 5114 (54%) persons had no subclinical coronary atherosclerosis, 3483 (36%) had nonobstructive disease, and 936 (10%) had obstructive disease. Within a median follow-up of 3.5 years (range, 0.1 to 8.9 years), 193 persons died and 71 had myocardial infarction. The risk for myocardial infarction was increased in persons with obstructive (adjusted relative risk, 9.19 [95% CI, 4.49 to 18.11]) and extensive (7.65 [CI, 3.53 to 16.57]) disease. The highest risk for myocardial infarction was noted in persons with obstructive-extensive subclinical coronary atherosclerosis (adjusted relative risk, 12.48 [CI, 5.50 to 28.12]) or obstructive-nonextensive (adjusted relative risk, 8.28 [CI, 3.75 to 18.32]). The risk for the composite end point of death or myocardial infarction was increased in persons with extensive disease, regardless of degree of obstruction-for example, nonobstructive-extensive (adjusted relative risk, 2.70 [CI, 1.72 to 4.25]) and obstructive-extensive (adjusted relative risk, 3.15 [CI, 2.05 to 4.83]).

LIMITATION: Mostly White persons were studied.

CONCLUSION: In asymptomatic persons, subclinical, obstructive coronary atherosclerosis is associated with a more than 8-fold elevated risk for myocardial infarction.

PRIMARY FUNDING SOURCE: AP Møller og Hustru Chastine Mc-Kinney Møllers Fond.

Original languageEnglish
JournalAnnals of Internal Medicine
Issue number4
Pages (from-to)433-442
Number of pages10
Publication statusPublished - Apr 2023


  • Coronary Angiography
  • Coronary Artery Disease/complications
  • Denmark/epidemiology
  • Humans
  • Myocardial Infarction/epidemiology
  • Prognosis
  • Prospective Studies
  • Risk Factors


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