Systematic Coronary Risk Evaluation estimated risk and prevalent subclinical atherosclerosis in coronary and carotid arteries: A population-based cohort analysis from the Swedish Cardiopulmonary Bioimage Study.

Carl Johan Östgren ,Tomas Jernberg,Kerstin Cederlund,Jonas Persson,Oskar Angerås,Karin Festin,Mats Eliasson,Erika Fagman,John Brandberg,Johan Sundström,Anders Blomberg,Anders Persson,Gunnar Engström,Jonas Oldgren,Ulf Nilsson,Eva Swahn,Margaretha Persson,Lars Lind,Annika Rosengren,Ellen Ostenfeld,Emil Hagström,David Erlinge,Stefan Söderberg,Göran Bergström,Jan Engvall ,Maria Nastase Mannila

doi:10.1177/2047487320909300

Abstract

It is not clear if the European Systematic Coronary Risk Evaluation algorithm is useful for identifying prevalent subclinical atherosclerosis in a population of apparently healthy individuals. Our aim was to explore the association between the risk estimates from Systematic Coronary Risk Evaluation and prevalent subclinical atherosclerosis. The design of this study was as a cross-sectional analysis from a population-based study cohort. From the general population, the Swedish Cardiopulmonary Bioimage Study randomly invited individuals aged 50-64 years and enrolled 13,411 participants mean age 57 (standard deviation 4.3) years; 46% males between November 2013-December 2016. Associations between Systematic Coronary Risk Evaluation risk estimates and coronary artery calcification and plaques in the carotid arteries by using imaging data from a computed tomography of the heart and ultrasonography of the carotid arteries were examined. Coronary calcification was present in 39.5% and carotid plaque in 56.0%. In men, coronary artery calcium score >0 ranged from 40.7-65.9% and presence of carotid plaques from 54.5% to 72.8% in the age group 50-54 and 60-65 years, respectively. In women, the corresponding difference was from 17.1-38.9% and from 41.0-58.4%. A doubling of Systematic Coronary Risk Evaluation was associated with an increased probability to have coronary artery calcium score >0 (odds ratio: 2.18 (95% confidence interval 2.07-2.30)) and to have >1 carotid plaques (1.67 (1.61-1.74)). Systematic Coronary Risk Evaluation estimated risk is associated with prevalent subclinical atherosclerosis in two major vascular beds in a general population sample without established cardiovascular disease or diabetes mellitus. Thus, the Systematic Coronary Risk Evaluation risk chart may be of use for estimating the risk of subclinical atherosclerosis.

Highlights

The mortality from coronary artery disease is declining in developed countries, but cardiovascular disease is still a leading cause of mortality and morbidity.[1]
Systematic Coronary Risk Evaluation estimated risk is associated with prevalent subclinical atherosclerosis in two major vascular beds in a general population sample without established cardiovascular disease or diabetes mellitus
The distribution of CACS > 0 and CACS 100 and atherosclerosis in the carotid arteries in relation to sex and age is shown in Figure 2(a)–(d) and in different Systematic Coronary Risk Evaluation (SCORE) categories is further illustrated in Figure 3(a) and (b), respectively

Summary

Introduction

The mortality from coronary artery disease is declining in developed countries, but cardiovascular disease is still a leading cause of mortality and morbidity.[1]. An updated SCORE algorithm for Sweden was recently shown to more adequately predict the number of cardiovascular deaths compared with the previous version.[4] In addition to the 10-year absolute risk of a fatal cardiovascular event, information about the probability that an atherosclerotic disease is already present may increase the awareness of risk and thereby improve the patient’s motivation and call for specific secondary prevention measures.[5] it is not clear if the SCORE algorithm is useful for identifying subclinical atherosclerosis in a population of apparently healthy individuals and there are, so far, no SCORE charts indicating the risk of prevalent subclinical atherosclerosis. Sweden 2Department of Public Health and Clinical Medicine, Umea University, Sweden 3Department of Cardiology, Sahlgrenska University Hospital, Sweden 4Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden 5Department of Clinical Physiology, Sahlgrenska University Hospital, Sweden 6Department of Radiology, Sahlgrenska University Hospital, Sweden 7Department of Radiology, University of Gothenburg, Sweden 8Department of Clinical Science, Intervention and Technology, Karolinska

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