TY - JOUR
T1 - Subclinical Coronary Atherosclerosis and Risk for Myocardial Infarction in a Danish Cohort
T2 - A Prospective Observational Cohort Study
AU - Fuchs, Andreas
AU - Kühl, Jørgen Tobias
AU - Sigvardsen, Per Ejlstrup
AU - Afzal, Shoaib
AU - Knudsen, Andreas Dehlbæk
AU - Møller, Mathias Bech
AU - de Knegt, Martina Chantal
AU - Sørgaard, Mathias Holm
AU - Nordestgaard, Børge Grønne
AU - Køber, Lars Valeur
AU - Kofoed, Klaus Fuglsang
PY - 2023/4
Y1 - 2023/4
N2 - 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.
AB - 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.
KW - Coronary Angiography
KW - Coronary Artery Disease/complications
KW - Denmark/epidemiology
KW - Humans
KW - Myocardial Infarction/epidemiology
KW - Prognosis
KW - Prospective Studies
KW - Risk Factors
UR - http://www.scopus.com/inward/record.url?scp=85152628492&partnerID=8YFLogxK
U2 - 10.7326/M22-3027
DO - 10.7326/M22-3027
M3 - Journal article
C2 - 36972540
VL - 176
SP - 433
EP - 442
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
SN - 0003-4819
IS - 4
ER -