Coronary Atherosclerosis in Asymptomatic Adults Undergoing Primary Prevention Assessment

Coronary plaque was detected by CCTA in 49% of participants.

More advanced findings were less common. 6% had coronary stenosis ≥50%. Stenosis ≥70% was present in 1.8%. Plaque with at least one high-risk feature was found in 7%.

58% of participants had CAC=0. However, 16% of this group still had coronary plaque on CCTA.

More advanced coronary findings were uncommon when CAC=0. Only 0.8% had stenosis ≥50%. Stenosis ≥70% was present in 0.1%. High-risk plaque was found in 2.3%.

Older age, male sex, smoking, diabetes, overweight and obesity independently predicted coronary plaque and high-risk plaque.

Among participants with CAC=0, male sex, overweight and obesity independently predicted coronary plaque.

Coronary atherosclerosis can develop long before symptoms appear. In this study, almost half of the asymptomatic participants already had detectable coronary plaque.

The study also shows an important difference between coronary calcium and coronary plaque.

CAC scoring detects calcified atherosclerosis. CCTA can also detect non-calcified plaque. In fact, 14.8% of participants with CAC=0 had non-calcified plaque on CCTA.

At the same time, CAC=0 was reassuring. Significant coronary narrowing and high-risk plaque were uncommon in this group.

These findings support a more individualized approach to cardiovascular prevention. Risk factors estimate the probability of cardiovascular disease. Imaging can provide information about atherosclerosis that is already present.

The Miami Heart Study does not establish CCTA as a routine screening test for all asymptomatic adults.

This was a cross-sectional study. It identified coronary plaque at one point in time. It did not assess whether CCTA screening reduces heart attacks or cardiovascular mortality.

The authors considered CAC=0 reassuring. Significant coronary stenosis and high-risk plaque were very uncommon in this group.

However, CAC=0 did not completely exclude coronary atherosclerosis. CCTA detected plaque in 16% of participants with CAC=0. Most plaque in this group was non-calcified.

The authors therefore identified a potential role for CCTA in selected higher-risk individuals. This may be relevant when management remains uncertain after clinical assessment and CAC scoring. They particularly highlighted people with multiple cardiovascular risk factors.

The study also reinforces the importance of prevention earlier in life. The authors specifically emphasized obesity, smoking and diabetes as important modifiable factors.

Long-term follow-up is needed. It will determine the prognostic significance of CCTA-detected plaque in asymptomatic adults.