• Andreas Fuchs, Jørgen Tobias Kühl, Per Ejlstrup Sigvardsen, Shoaib Afzal, Andreas Dehlbæk Knudsen, Mathias Bech Møller, Martina Chantal de Knegt, Mathias Holm Sørgaard, Børge Grønne Nordestgaard, Lars Valeur Køber, and Klaus Fuglsang Kofoed.
• Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark (A.F., J.T.K., P.E.S., A.D.K., M.B.M., M.C.deK., M.H.S.).
• Ann. Intern. Med. 2023 Apr 1; 176 (4): 433442433-442.

BackgroundCoronary atherosclerosis may develop at an early age and remain latent for many years.ObjectiveTo define characteristics of subclinical coronary atherosclerosis associated with the development of myocardial infarction.DesignProspective observational cohort study.SettingCopenhagen General Population Study, Denmark.Participants9533 asymptomatic persons aged 40 years or older without known ischemic heart disease.MeasurementsSubclinical 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.ResultsA 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]).LimitationMostly White persons were studied.ConclusionIn asymptomatic persons, subclinical, obstructive coronary atherosclerosis is associated with a more than 8-fold elevated risk for myocardial infarction.Primary Funding SourceAP Møller og Hustru Chastine Mc-Kinney Møllers Fond.

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