4 in 10 adults in Sweden have silent coronary disease
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In the general Swedish population, 4 in 10 middle-aged adults have silent CAD and 1 in 20 have severe CAD on coronary CT angiography, according to new data from the Swedish Cardiopulmonary Bioimage Study.
Researchers also found that a model based on factors easily attainable at home predicted CAD just as well as a model using clinical data.
This is the first report from the large SCAPIS project, a collaborative effort between six universities in Sweden that aims to reduce risk for CV and respiratory diseases for generations to come, Göran Bergström, MD, PhD, professor and lead physician at Sahlgrenska Academy, Gothenburg University, Sweden, said during a press conference at the virtual American Heart Association Scientific Sessions.
SCAPIS included more than 300,000 men and women aged 50 to 64 years who had no history of prior MI or cardiac intervention. Participants responded to questions about sex, age, smoking, body measurements, cholesterol medications and BP to predict their risk for CAD. Researchers then used coronary CT angiography (CCTA) images to examine patients’ arteries for the presence of plaque. More than 25,000 individuals from the original sample were successfully imaged.
“This is the first time that CCTA is used in such a large sample of the general population,” Bergström said.
The imaging results found that silent CAD was common, with 42% of participants having atherosclerosis. Clinically significant severe silent CAD, which Bergström classified as atherosclerosis that obstructs blood flow in the arteries, was observed in 5% of participants on CCTA.
There was a “clear increase” in the prevalence of CAD in older adults and in men, as well as in those with traditional risk factors, he said.
The highest frequency of plaques was in the proximal LAD, with a similar distribution regardless of sex and severity of disease.
A second aim of the study was to develop a personalized screening strategy to identify individuals at high risk for widespread but still silent CAD. Using machine learning, the researchers developed a personalized risk algorithm based on approximately 120 different risk factors to identify which combination of exposures best predicted widespread atherosclerosis in more than four segments. The researchers developed two prediction models: The “home model” was based on data easily obtained at home, such as weight and waist circumference, and the “clinical model” incorporated factors such as cholesterol levels and BP measurements.
When the researchers compared the two models, the home model had high accuracy (AUC, 0.8) and was equally effective to the clinical model, and could identify two-thirds of all individuals with more than four diseased segments, Bergström said.
“Using a home-based test, we can, with reasonable precision, predict who has widespread CAD without requiring health care resources,” he said. “We hope these findings can be developed into a future screening strategy; this strategy could involve simple home-based tests to first select individuals with a high likelihood of having silent CAD and then define this risk further using CCTA imaging. This could lead to early detection of CAD so we can provide preventive treatment to those at the highest risk and decrease the risk of future heart attacks.”
During a discussant presentation following the trial, Pamela S. Douglas, MD, MACC, FASE, FAHA, the Ursula Geller Professor of Research in Cardiovascular Disease at Duke University, said the home-based risk score is “innovative with important implications” for public health.
Additionally, “the SCAPIS proposal to use CCTA only in individuals with high clinical risk requires prospective validation, including ensuring that all prognostically significant nonobstructive CAD is detected, so this at-risk group is not undertreated,” Douglas said. “Once validated prospectively, randomized controlled trials are needed to determine if the SCAPIS algorithm, cut point and tiered approach of conditional CCTA will improve outcomes and be cost effective compared to usual care, or an as-yet untested imaging-driven strategy of CCTA for all.”
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Bergström G, et al. LBS.02: Bending the Curve for CV Disease - Precision or PolyPill? Presented at: American Heart Association Scientific Sessions; Nov. 13-17, 2020 (virtual meeting).
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