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November 13, 2020
2 min of reading
Source / Disclosures
Bergström G, et al. LBS.02: Bending the Curve for CV Disease – Precision or PolyPill? Presented at: American Heart Association Scientific Sessions; 13-17 November 2020 (virtual meeting).
Disclosures:
Bergström and Douglas do not report material financial information.
In the general Swedish population, 4 out of 10 middle-aged adults have silent CAD and 1 in 20 have severe CAD on coronary CT angiography, according to new data from the Swedish Cardiopulmonary Bioimage Study.
The researchers also found that a factor-based model easily obtainable at home predicted CAD just like a model that used clinical data.
Source: Adobe Stock.
This is the first report from the major SCAPIS project, a collaborative effort between six universities in Sweden that aims to reduce the risk of CV and respiratory diseases for generations to come, Göran Bergström, MD, PhD, Professor and chief physician at the Sahlgrenska Academy, University of Gothenburg, Sweden, said during a press conference at the American Heart Association’s virtual science sessions.
SCAPIS included more than 300,000 men and women between the ages of 50 and 64 who had no history of myocardial infarction or heart surgery. Participants answered questions about gender, age, smoking, body measurements, cholesterol medications, and BP to predict CAD risk. The researchers then used CT coronary angiography (CCTA) images to examine the patients’ arteries for the presence of plaque. More than 25,000 individuals from the original sample were successfully imaged.
“This is the first time that the CCTA has been used in such a large sample of the general population,” Bergström said.
The imaging results found that silent CAD was common, with 42% of the participants presenting with atherosclerosis. Clinically significant severe silent CAD, which Bergström classified as atherosclerosis obstructing blood flow in the arteries, was observed in 5% of CCTA participants.
There was a “clear increase” in the prevalence of CAD in the elderly and in men, as well as those with traditional risk factors, he said.
The highest frequency of plaques was in proximal LAD, with a similar distribution regardless of gender and disease severity.
A second goal of the study was to develop a personalized screening strategy to identify people at high risk for widespread but still silent CAD. Using machine learning, the researchers developed a customized risk algorithm based on around 120 different risk factors to identify which combination of exposures best predicted widespread atherosclerosis in more than four segments. Researchers developed two prediction models: the ‘home model’ was based on readily obtainable data at home, such as weight and waist circumference, and the ‘clinical model’ included factors such as cholesterol levels and BP measurements. .
When the researchers compared the two models, the home model had high accuracy (AUC, 0.8) and was equally effective for the clinical model and could identify two-thirds of all individuals with more than four diseased segments. called Bergström.
“Using a home test, we can, with reasonable accuracy, predict who has widespread CAD without requiring healthcare resources,” he said. “We hope that these findings can be developed into a future screening strategy; this strategy could involve simple home testing to first select people with a high likelihood of having silent CAD and then further define this risk using CCTA imaging. This could lead to early diagnosis of CAD so that preventative treatment can be provided to those at highest risk and reduce the risk of future heart attacks.
Pamela S. Douglas
During a post-trial discussion presentation, Pamela S. Douglas, MD, MACC, PHASE, FAHA, Ursula Geller, a research professor on cardiovascular disease at Duke University, said the home-based risk score is “groundbreaking with important implications” for public health.
Additionally, “SCAPIS ‘proposal to use CCTA only in high clinical risk individuals requires prospective validation, including ensuring that all prognostically significant non-obstructive CAD are detected, so this risk group is not under treatment,” said Douglas . “Once validated prospectively, randomized controlled trials are needed to determine whether the SCAPIS algorithm, cutoff point and layered approach of the conditional CCTA will improve outcomes and be cost-effective over usual care, or a Imaging-driven CCTA not yet tested for everyone. “
American Heart Association
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