What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Apparently healthy individuals (n=13411). Intervention: Systematic Coronary Risk Evaluation (SCORE) estimated risk. Primary outcome: Coronary artery calcium score >0 (OR 2.18, 95% CI 2.07-2.30).

March 3, 2020Open Access

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

Key Result

A doubling of Systematic Coronary Risk Evaluation estimated risk was associated with increased odds of coronary artery calcium score >0 (OR 2.18; 95% CI 2.07-2.30) and >1 carotid plaques.

Study Design

Type

Cross-Sectional (n=13,411)

Structured PICO

Is the Systematic Coronary Risk Evaluation (SCORE) algorithm associated with prevalent subclinical atherosclerosis in apparently healthy individuals?

Population

13,411 apparently healthy individuals aged 50-64 years without established cardiovascular disease or diabetes mellitus from the general Swedish population.

Exposure

Systematic Coronary Risk Evaluation (SCORE) algorithm risk estimates

Outcome

Prevalent subclinical atherosclerosis (coronary artery calcification and plaques in the carotid arteries measured by CT and ultrasonography)surrogate

The Systematic Coronary Risk Evaluation (SCORE) algorithm is significantly associated with prevalent subclinical atherosclerosis in the coronary and carotid arteries among apparently healthy individuals.

Main Result

Odds Ratio: 2.18 (95% CI 2.07–2.3)

Abstract

BACKGROUND: 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. DESIGN: The design of this study was as a cross-sectional analysis from a population-based study cohort. METHODS: 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. RESULTS: 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)). CONCLUSION: 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.