A new study out of Denmark suggests that coronary CTA could be headed for population-based screening for heart disease. Researchers found that CCTA was remarkably effective in identifying individuals without symptoms who were more likely to experience heart attacks in years to come.
CCTA has proven so effective for cardiac imaging that it’s become a first-line test for stable chest pain, usually for those with symptoms. But researchers have debated whether CCTA’s value could be extended to asymptomatic individuals – which could set the stage for broad-based heart disease screening programs.
To investigate CCTA’s potential in the asymptomatic, researchers in Denmark scanned 9,533 individuals 40 years and older as part of the Copenhagen General Population Study, reporting their results in Annals of Internal Medicine. CCTA scans were conducted with Canon Medical’s 320-detector-row Aquilion One Vision scanner.
Atherosclerosis was characterized as either obstructive (a luminal stenosis ≥ 50%), extensive (stenoses widely prevalent but not obstructive), or both. Researchers then tracked myocardial events over a median follow-up of 3.5 years.
They found that 46% of study subjects had evidence of subclinical coronary atherosclerosis, with the type of atherosclerosis impacting risk of myocardial infarction:
- Extensive atherosclerosis had eight times higher risk
- Obstructive atherosclerosis had nine times higher risk
- Both extensive and obstructive disease had 12 times higher risk
What’s more, researchers found that 10% of their study population had obstructive disease – which is just 10 percentage points under the 60% atherosclerosis threshold at which therapeutic intervention should be considered for asymptomatic people.
Participants in the CGPS study did not receive treatment as part of the study, but the researchers have a follow-up study underway – DANE-HEART – in which asymptomatic people will get CCTA scans and some will be directed to preventive treatment if they meet clinical guidelines.
This study demonstrates not only the widespread incidence of subclinical coronary atherosclerosis, but also CCTA’s ability to detect CAD before symptoms appear. Preventive treatment initiated and directed by CT findings could have a major impact on heart disease morbidity and mortality.
Given CCTA’s prognostic ability and the heavy burden of heart disease on society (more women die of heart disease than breast cancer, for example), how long before calls emerge to add CT-based heart screening to the arsenal of population-based screening programs? DANE-HEART may offer a clue.