Coronary atherosclerosis -- detected on coronary CT angiography (CCTA) -- increases a person's risk of heart attack eight-fold, a study published on 28 March in the Annals of Internal Medicine has found.
The findings sound a warning to clinicians regarding monitoring patients with poor heart health.
"Coronary atherosclerosis may develop at an early age and remain latent for many years," wrote a team led by Dr. Andreas Fuchs, PhD, of Copenhagen University Hospital-Rigshospitalet in Denmark.
Fuchs and colleagues sought to define any characteristics of not-yet-apparent coronary atherosclerosis that could lead to heart attack, conducting a study that used data from the Copenhagen General Population Study (CGPS), which began in 2003 and recruited participants from the general population of Copenhagen, Denmark, to assess heart health.
This study included 9,533 asymptomatic patients ages 40 and over without known ischemic heart disease; each underwent CCTA, with exam readers blinded to treatment and outcomes. Fuchs and colleagues defined atherosclerosis by the percentage of luminal obstruction (non-obstructive or obstructive [i.e., ≥ 50% luminal stenosis] and nonextensive or extensive (i.e., one third or more of coronary tree). The research's primary outcome was heart attack.
The authors found the following:
- 54% of the study cohort had no subclinical heart atherosclerosis.
- 36% of the cohort had non-obstructive disease, while 10% had obstructive disease.
- In a median follow-up timeframe of 3.5 years, 193 people died and 71 had heart attacks.
- Adjusted relative risk of heart attack was higher in people with obstructive and extensive disease (9.2 and 7.7, respectively, with 1 as reference).
- People with obstructive/extensive subclinical atherosclerosis had an adjusted relative risk of heart attack of 12.5 (reference, 1), while those with obstructive/non-extensive disease had a risk of 8.3.
The study results shed further light on the connection between atherosclerosis and heart attack, according to Fuchs and colleagues.
"In asymptomatic persons, subclinical, obstructive coronary atherosclerosis is associated with a more than eight-fold elevated risk for myocardial infarction," they concluded.
![Overview of the study design. (A) The fully automated deep learning framework was developed to estimate body composition (BC) (defined as subcutaneous adipose tissue [SAT] in liters; visceral adipose tissue [VAT] in liters; skeletal muscle [SM] in liters; SM fat fraction [SMFF] as a percentage; and intramuscular adipose tissue [IMAT] in deciliters) from MRI. The fully automated framework comprised one model (model 1) to quantify different BC measures (SAT, VAT, SM, SMFF, and IMAT) as three-dimensional (3D) measures from whole-body MRI scans. The second model (model 2) was trained to identify standardized anatomic landmarks along the craniocaudal body axis (z coordinate field), which allowed for subdividing the whole-body measures into different subregions typically examined on clinical routine MRI scans (chest, abdomen, and pelvis). (B) BC was quantified from whole-body MRI in over 66,000 individuals from two large population-based cohort studies, the UK Biobank (UKB) (36,317 individuals) and the German National Cohort (NAKO) (30,291 individuals). Bar graphs show age distribution by sex and cohort. BMI = body mass index. (C) After the performance assessment of the fully automated framework, the change in BC measures, distributions, and profiles across age decades were investigated. Age-, sex-, and height-adjusted body composition reference curves were calculated and made publicly available in a web-based z-score calculator (https://circ-ml.github.io).](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/05/body-comp.XgAjTfPj1W.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
