Silent Heart Disease Common, Easily Identified With At-Home Questionnaire

About 40% of middle-aged adults have silent coronary atherosclerosis on coronary CT angiography (CCTA), according to results of the Swedish CardioPulmonary BioImage Study (SCAPIS).

Using a home-based questionnaire "we can with reasonable precision predict who has widespread coronary-artery disease without requiring healthcare resources and we hope that these findings can be developed into a future screening strategy," Dr. Goeran Bergstroem of Sahlgrenska Academy, Gothenburg University, in Sweden, said during a November 13 press briefing at the American Heart Association (AHA) 2020 virtual scientific sessions.

The SCAPIS cohort includes more than 30,000 men and women aged 50 to 64 years with no history of heart attack or cardiac intervention. Of these, 25,182 underwent CCTA.

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Evidence of silent coronary-artery disease (CAD) was found in 42% of participants; 5% had severe subclinical CAD. "These individuals have atherosclerosis that potentially could lead to heart attack and angina," Dr. Bergstroem noted.

A higher prevalence of silent CAD was seen in men and older adults and those with traditional risk factors for heart disease.

The researchers developed a home-based screening questionnaire and found it successfully predicted which individuals had widespread but silent CAD.

"We hope that these findings can be developed into a future screening strategy. This strategy could involve simple home-based tests to first select individuals with a high likelihood of having silent CAD and then define this risk further using imaging. This would lead to early detection of CAD so we can provide preventive treatment to those at the highest risk features," Dr. Bergstroem said.

Commenting on the research, Dr. Pamela Douglas of Duke University, Durham, North Carolina, said the team should be congratulated on creating "a very rich data set for current and future study. The SCAPIS study has already yielded novel data on the prevalence of coronary-artery disease in the general population, and will address many critical questions over the long term," she told the briefing.

She cautioned, however, that their "proposal to use CCTA only in those with high clinical risk requires perspective validation, including ensuring that all prognostically significant non-obstructive CAD is detected so this at-risk group is not under-treated."

"Once validated prospectively as an algorithm or diagnostic strategy, randomized controlled trials are needed to determine if the SCAPIS algorithm cutpoint and tiered approach, or conditional CTA, will improve outcomes and be cost-effective compared to usual care using risk factors alone or an as yet untested imaging-driven strategy such as CTA or calcium scoring for all," she said.

Funding for the study was provided by the Swedish Heart and Lung Foundation. The authors have declared no relevant conflicts of interest.

—Megan Brooks

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