Comprehensive Prediction of Subclinical Coronary Atherosclerosis in Subjects Without Traditional Cardiovascular Risk Factors

초록

It is not uncommon for asymptomatic individuals without identified cardiovascular risk factors to present with atherosclerosis-related adverse events. We aimed to evaluate the predictors of subclinical coronary atherosclerosis in individuals without traditional car-diovascular risk factors. We analyzed 2,061 individuals without identified cardiovascular risk factors who voluntarily underwent coronary computed tomography angiography as part of a general health examination. Subclinical atherosclerosis was defined as the pres-ence of any coronary plaque. Of 2,061 individuals, subclinical atherosclerosis was observed in 337 individuals (16.4%). Clinical variables, such as age, gender, body mass index (BMI), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), were significantly associated with sub -clinical coronary atherosclerosis. The participants were randomly split into train and vali-dation data sets. In the train set, a prediction model using 6 variables with optimal cutoffs (age >53 years for men and >55 years for women, gender, BMI >22 kg/m2, SBP >120 mm Hg, HDL-C <55 mg/100 ml, and LDL-C >130 mg/100 ml) was derived (area under the curve 0.780, 95% confidence interval 0.751 to 0.809, goodness-of-fit p = 0.693). In the validation set, this model performed well (area under the curve 0.792, 95% confi-dence interval 0.726 to 0.858, goodness-of-fit p = 0.073). In conclusion, together with non -modifiable risk factors, such as age and gender, modifiable variables, such as BMI, SBP, LDL-C, and HDL-C, were shown to be associated with subclinical coronary atherosclero-sis, even at currently acceptable levels. These results suggest that stricter control of BMI, blood pressure, and cholesterol might be helpful in the primary prevention of future coro-nary events. (c) 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;198:64-71)

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