Evidence map›Paper›PMID 34543072›Full record

ArticleCirculation2021

Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population.

Göran Bergström, Margaretha Persson, Martin Adiels, Elias Björnson, Carl Bonander, Håkan Ahlström, Joakim Alfredsson, Oskar Angerås, Göran Berglund, Anders Blomberg and 37 more

Open access · bronzeAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 225 papers.

0numbers the graph read from it
0cells of the map it votes in
225citing papers in PubMed
36.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

225 citing papers in PubMed, 393 citations in OpenAlex.

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  16. Linking Lipidomics to Vulnerable Coronary Plaques: A PROSPECT II Substudy.Arteriosclerosis, thrombosis, and vascular biology · 2026
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  19. Observational
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165 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

47 authors at 14 institutions in 5 countries.

Göran BergströmDepartment of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden.ORCID 0000-0003-4289-5722
Margaretha PerssonDepartment of Clinical Sciences (M.P., G. Berglund, G.E., M. Magnusson), Lund University, Malmö, Sweden.ORCID 0000-0001-8188-5792
Martin AdielsSahlgrenska Academy, and School of Public Health and Community Medicine, Institute of Medicine (M.A., C.B.), University of Gothenburg, Sweden.ORCID 0000-0002-3667-589X
Elias BjörnsonDepartment of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden.
Carl BonanderSahlgrenska Academy, and School of Public Health and Community Medicine, Institute of Medicine (M.A., C.B.), University of Gothenburg, Sweden.ORCID 0000-0002-1189-9950
Håkan AhlströmSection of Radiology, Department of Surgical Sciences (H.A., O.D.), Uppsala University, Sweden.
Joakim AlfredssonDepartments of Cardiology (J.A., E.S.), Linköping University, Sweden.
Oskar AngeråsDepartment of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden.
Göran BerglundDepartment of Clinical Sciences (M.P., G. Berglund, G.E., M. Magnusson), Lund University, Malmö, Sweden.
Anders BlombergDepartment of Public Health and Clinical Medicine, Medicine and Heart Centre (A.B., J.L., A. Sandström, A. Själander, S.S.), Umeå University, Sweden.
John BrandbergDepartment of Radiology, Institute of Clinical Sciences (J.B., E.F., A.F.), University of Gothenburg, Sweden.
Mats BörjessonInstitute of Medicine (M.B.), University of Gothenburg, Sweden.ORCID 0000-0002-8786-0438
Kerstin CederlundDepartment of Clinical Science, Intervention and Technology (K.C.), Karolinska Institutet, Stockholm, Sweden.
Ulf de FaireUnit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine (U.d.F.), Karolinska Institutet, Stockholm, Sweden.ORCID 0000-0002-6000-3698
Olov DuvernoySection of Radiology, Department of Surgical Sciences (H.A., O.D.), Uppsala University, Sweden.
Örjan EkblomDepartment of Physical Activity and Health, The Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden (Ö.E.).ORCID 0000-0001-6058-4982
Gunnar EngströmDepartment of Clinical Sciences (M.P., G. Berglund, G.E., M. Magnusson), Lund University, Malmö, Sweden.ORCID 0000-0002-8618-9152
Jan E EngvallHealth, Medicine and Caring Sciences (J.A., E.S., J.E.E., F.H.N., C.J.Ö., A.P.), Linköping University, Sweden.ORCID 0000-0002-5716-5098
Erika FagmanDepartment of Radiology, Institute of Clinical Sciences (J.B., E.F., A.F.), University of Gothenburg, Sweden.ORCID 0000-0002-0983-0313
Mats ErikssonDepartment of Endocrinology, Metabolism & Diabetes and Clinical Research Center, Karolinska University Hospital Huddinge, Stockholm, Sweden (M.E.).ORCID 0000-0001-6481-5549
David ErlingeDepartment of Clinical Sciences Lund, Cardiology, Lund University and Skåne University Hospital, Lund, Sweden (D.E., M.A.M.).
Björn FagerbergDepartment of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden.ORCID 0000-0003-0575-1375
Agneta FlinckDepartment of Radiology, Institute of Clinical Sciences (J.B., E.F., A.F.), University of Gothenburg, Sweden.
Isabel GonçalvesDepartment of Clinical Sciences Malmö (I.G.), Lund University and Skåne University Hospital, Lund, Sweden.
Emil HagströmCardiology (E.H.), Uppsala University, Sweden.
Ola HjelmgrenDepartment of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden.ORCID 0000-0002-8639-6928
Lars LindClinical Epidemiology (L.L., J.S.), Uppsala University, Sweden.ORCID 0000-0003-2335-8542
Eva LindbergRespiratory, Allergy and Sleep Research (E.L.), Uppsala University, Sweden.
Per LindqvistDepartment of Surgical and Perioperative Sciences (P.L.), Umeå University, Sweden.
Johan LjungbergDepartment of Public Health and Clinical Medicine, Medicine and Heart Centre (A.B., J.L., A. Sandström, A. Själander, S.S.), Umeå University, Sweden.
Martin MagnussonDepartment of Clinical Sciences (M.P., G. Berglund, G.E., M. Magnusson), Lund University, Malmö, Sweden.
Maria MannilaHeart and Vascular Theme, Department of Cardiology, and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden (M. Mannila).
Hanna MarkstadExperimental Cardiovascular Research, Clinical Research Center, Clinical Sciences Malmö (H.M.), Lund University, Malmö, Sweden.
Moman A MohammadDepartment of Clinical Sciences Lund, Cardiology, Lund University and Skåne University Hospital, Lund, Sweden (D.E., M.A.M.).ORCID 0000-0003-4242-9801
Fredrik H NystromHealth, Medicine and Caring Sciences (J.A., E.S., J.E.E., F.H.N., C.J.Ö., A.P.), Linköping University, Sweden.ORCID 0000-0002-1680-1000
Ellen OstenfeldDepartment of Clinical Sciences Lund, Clinical Physiology (E.O.), Lund University and Skåne University Hospital, Lund, Sweden.ORCID 0000-0002-2655-2423
Anders PerssonHealth, Medicine and Caring Sciences (J.A., E.S., J.E.E., F.H.N., C.J.Ö., A.P.), Linköping University, Sweden.ORCID 0000-0002-9446-6981
Annika RosengrenDepartment of Molecular and Clinical Medicine (G. Bergström, E.B., O.A., B.F., O.H., A.R.), University of Gothenburg, Sweden.ORCID 0000-0002-5409-6605
Anette SandströmDepartment of Public Health and Clinical Medicine, Medicine and Heart Centre (A.B., J.L., A. Sandström, A. Själander, S.S.), Umeå University, Sweden.ORCID 0000-0002-3350-9001
Anders SjälanderDepartment of Public Health and Clinical Medicine, Medicine and Heart Centre (A.B., J.L., A. Sandström, A. Själander, S.S.), Umeå University, Sweden.ORCID 0000-0001-9422-1186
Magnus C SköldRespiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine (M.C.S.), Karolinska Institutet, Stockholm, Sweden.
Johan SundströmClinical Epidemiology (L.L., J.S.), Uppsala University, Sweden.ORCID 0000-0003-2247-8454
Eva SwahnDepartments of Cardiology (J.A., E.S.), Linköping University, Sweden.
Stefan SöderbergDepartment of Public Health and Clinical Medicine, Medicine and Heart Centre (A.B., J.L., A. Sandström, A. Själander, S.S.), Umeå University, Sweden.ORCID 0000-0001-9225-1306
Kjell TorénOccupational and Environmental Medicine/School of Public Health and Community Medicine (K.T.), University of Gothenburg, Sweden.
Carl Johan ÖstgrenHealth, Medicine and Caring Sciences (J.A., E.S., J.E.E., F.H.N., C.J.Ö., A.P.), Linköping University, Sweden.ORCID 0000-0003-1617-3179
Tomas JernbergDepartment of Clinical Sciences, Danderyd University Hospital (T.J.), Karolinska Institutet, Stockholm, Sweden.ORCID 0000-0003-1695-379X
Lund University · SELinköping University · SEUmeå University · SEUppsala University · SEKarolinska University Hospital · SESahlgrenska University Hospital · SEBerge (Sweden) · SEScandinavian Automotive Supplier Association · SEKarolinska Institutet · SENational Academy of Medicine · USMalmö University · SERegion Västra Götaland · SESkåne University Hospital · SESwedish School of Sport and Health Sciences · SE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEarly detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.

methodsWe recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.

resultsIn total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.

conclusionsUsing CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.

Indexed as

AtherosclerosisCohort StudiesComputed Tomography AngiographyCoronary Artery DiseaseFemaleHumansMaleMiddle AgedPrevalenceSwedenVascular Calcificationcoronary angiographycoronary artery diseaseepidemiologyplaque, atheroscleroticprimary preventiontomography

Identifiers

PMID34543072
PMCPMC8448414
OpenAlexW3200704993

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.