Prevalence of coronary artery disease on coronary CT angiography in asymptomatic, predominantly high-risk Indian adults: A single-centre cross-sectional study

BACKGROUND: Coronary artery disease (CAD) in South Asians often develops at a younger age and may not be adequately detected by conventional risk stratification or coronary artery calcium scoring (CACS). In this study we assessed the prevalence of CAD in asymptomatic, predominantly physician-referred individuals undergoing coronary CT angiography (CCTA). METHODS: This single-centre cross-sectional study included 1,750 asymptomatic individuals, predominantly physician-referred for cardiovascular risk assessment, who underwent CCTA between 2019 and 2024. Clinical risk factors, Framingham risk score (FRS), and CACS were recorded. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of CAD. Prevalence of CAD in low FRS and CACS was further analysed. RESULTS: CAD was detected in 1,084 individuals (62%), including 787 (45%) with non-obstructive and 297 (17%) with obstructive disease, while coronary calcification (CACS >0) was seen in 957 (54.6%) patients. Increasing FRS scores were associated with increased CAD prevalence (p < 0.001). Increasing CACS was also associated with CAD severity (p < 0.001). On multivariable logistic regression, independent predictors of CAD included age (OR 1.09 per year, 95%CI 1.08-1.11), male sex (OR 2.20, 95%CI 1.55-3.13), diabetes (OR 2.07, 95%CI 1.56-2.76), hypertension (OR 1.47, 95%CI 1.09-1.98), obesity (OR 1.45, 95%CI 1.00-2.10), and elevated LDL/HDL ratio>4 (OR 1.93, 95%CI 1.22-3.04). CONCLUSION: In this selected cohort of asymptomatic, predominantly high-risk Indian adults referred for CCTA, subclinical coronary atherosclerosis was common, including among individuals with low Framingham risk or zero coronary calcium. Whether detecting such disease with CCTA improves outcomes or is cost-effective requires prospective, outcome-based evaluation.