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

N1 - Funding Information: Grant Support: By the AP Møller og Hustru Chastine Mc-Kinney Møllers Fond, Research Council of Rigshospitalet, and Danish Heart Foundation. Publisher Copyright: © 2023 American College of Physicians.

PY - 2023

Y1 - 2023

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.

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.

U2 - 10.7326/M22-3027

DO - 10.7326/M22-3027

M3 - Journal article

C2 - 36972540

AN - SCOPUS:85152628492

VL - 176

SP - 433

EP - 442

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 4

ER -