Bergstrom G, Persson M, Adiels M, et al. - A common prevalence of silent coronary atherosclerosis was found using coronary computed tomography angiography (CCTA) in a large, random sample of the general population without established disease. A significant likelihood of substantial stenosis was associated with high coronary artery calcification (CAC) scores, and 0 CAC did not exclude atherosclerosis, especially in individuals at higher baseline risk.

• This study involved 25,182 persons without known coronary heart disease (50.6% women) and with high-quality results from CCTA and CAC imaging.

• Employing CCTA, a common prevalence (42.1%) of silent coronary atherosclerosis, less common prevalence (5.2%) of significant stenosis (≥50%), and rare prevalence (1.9%) of more severe forms was found in a random sample of a middle-aged general population.

• In females, onset of atherosclerosis was delayed by 10 years, and atherosclerosis was more prevalent in older persons.

• CCTA-detected atherosclerosis prevalence rose with increasing CAC scores: atherosclerosis was evident in all those with a high CAC score (>400), and significant stenosis was seen in 45.7%, and 5.5% of those with 0 CAC were found to have atherosclerosis, and 0.4% had significant stenosis, with increasing prevalence at higher predicted risk.