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Eight-fold increased risk of heart attack in patients with undetected coronary condition

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April 1, 2023: Research from the University of Copenhagen in Denmark has found that asymptomatic people can also have an eightfold risk of heart disease due to undetected obstructive coronary atherosclerosis.

Study author Andreas Fuchs (Georg-August-Universität Göttingen, Göttingen, Germany) and others published the research in the Annals of Internal Medicine. They found coronary atherosclerosis can develop at an early age and remain latent for many years.Their findings also suggest nearly half of the adults over 40 may have such “hidden” heart conditions.

Coronary atherosclerosis and heart attack

Coronary atherosclerosis occurs when plaque from cholesterol deposits builds up inside the arteries that bring blood to the heart. Coronary atherosclerosis is the most common cause of heart attack.

According to Dr. Klaus Fuglsang Kofoed, clinical associate professor in the Department of Clinical Medicine at the University of Copenhagen in Denmark and corresponding author of this study decided to study the process of coronary atherosclerosis as it is responsible for heart attack and cardiac death.

The study authors used computed tomography angiography (CTA) to diagnose and guide treatment strategies for patients presenting with symptoms indicative of ischaemic heart disease. They examined over 9,500 people aged 40 or over who had no known symptoms of cardiovascular disease. Patients were followed and evaluated for a median of 3.5 years.

Upon analysis, researchers found 54% of the study participants had no detectable coronary atherosclerosis.

Of the remaining 46% that were found to have previously undetected coronary atherosclerosis, 36% of participants had nonobstructive disease, and 10% had obstructive disease. During the follow-up period, 193 participants died and 71 developed myocardial infarction(MI).  The risk of heart attack increased in persons with obstructive and extensive disease. Obstructive subclinical coronary atherosclerosis was associated with a more than eight-fold increased risk for MI, and the risk for either death or MI was increased two-fold in persons with extensive disease.

Additionally, scientists found among participants diagnosed with previously undetected coronary atherosclerosis, 61% were males, and 36% were females.

“The greatest surprise was that as high as 10% had obstructive diseases yet without having symptoms.

“[This is] a very important observation which we will explore further in additional analysis,” said Dr. Kofoed

Concerning the limitations of their study, the team said their study subject were “mostly white” participants. “Moreover, persons undergoing coronary CTA recorded in the study group tended to have fewer cardiovascular risk factors, a higher education level, and higher income class, adding to the limited applicability of their findings which should therefore be interpreted accordingly”, the authors remarked.

In 2019, about 17.9 million people globally died of heart disease, with 85% of those deaths attributed to stroke and myocardial infarction.

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