Coronary Artery Disease in Asymptomatic Young Adults: Its Prevalence According to Coronary Artery Disease Risk Stratification and the CT Characteristics

Abstract

ObjectiveWe aimed at evaluating the prevalence and CT characteristics of occult coronary artery disease (CAD) in young Korean adults under 40 years of age by performing coronary CT angiography (CCTA).Materials and MethodsWe retrospectively enrolled 112 consecutive asymptomatic subjects (90 men, mean age: 35.6 ± 3.7 years) who underwent CCTA as part of a general health evaluation. We classified the subjects into three National Cholesterol Education Program risk categories and we assessed the plaque characteristics on CCTA according to the number of involved vessels, the location and type of plaques and vascular remodeling.ResultsTwelve individuals had CAD (11%, 11 men). The prevalence of CAD was significantly higher in the subgroups with moderate (22%) or high (25%) risk than that in the low risk subgroup (5%) (p < 0.05). Nine patients had single-vessel disease and three patients had two-vessel disease. The most common location for plaque was the proximal left anterior descending coronary artery (60%). All the patients had non-significant stenosis and plaque, including the non-calcified (27%), mixed (47%) and calcified (27%) types. Positive vascular remodeling was identified in all the patients with non-calcified or mixed plaques.ConclusionThe prevalence of occult CAD was not negligible in the asymptomatic young adults with moderate to high risk, and this suggests the importance of management and risk factor modification in this population. All the patients had non-significant stenosis, and one fourth of the plaques did not show calcification.

Newer perspectives of coronary artery disease in young

“…The prevalence of occult CAD in 112 asymptomatic young individuals, less than 40 years of age, was found to be 11% (9 had single vessel disease and 3 had double vessel disease) in a study done in Korea. The occult CAD in these individuals was defined by performing coronary CT angiography[18]. …”

Role of Coronary Artery Calcium Score and Coronary CT Angiography in the Diagnosis and Risk Stratification of Individuals with Suspected Coronary Artery Disease

“…Early adult levels of modifiable risk factors at baseline predicted the presence of CACS by ages 33 to 45 years [95]. Similar findings between the relationship between the early development of coronary artery calcification and CCTA in young adults with established risk factors have been reported [96][97][98]. Future studies will need to be completed to further address the associations between childhood risk factors and disease end points and the need for earlier risk assessment.…”

Coronary artery disease detected by coronary computed tomography angiography in adult survivors of childhood Hodgkin lymphoma

“…Historically, screening has included echocardiography with variable follow‐up after the completion of therapy. The median age of patients with CAD in this study was 40 years, which is significantly younger for a diagnosis of CAD compared with a noncancer population, suggesting that this patient population requires more vigilant screening. Multidetector CCTA is a potentially useful screening modality for these patients.…”

“…In an investigation of adults without known CAD who were evaluated for nonemergent chest pain, researchers reported sensitivity, specificity, and positive and negative predictive values of 94%, 83%, 48%, and 99%, respectively, for CCTA in detecting ≥70% stenosis . Ha et al used CCTA to evaluate healthy young adults (aged ≤40 years) with no history of cancer and found that 11% of study participants had evidence of occult CAD, but no cases were obstructive. In the similarly young population in the current study, 10% of patients had obstructive disease; an additional 29% had nonobstructive lesions.…”