title: Cardiovascular risk among stable individuals suspected of having coronary artery disease with no modifiable risk factors: results from an international multicenter study of 5262 patients.
abstract: OBJECTIVE
  To assess the prevalence, extent, severity, and risk of coronary artery disease (CAD) in patients suspected of having CAD but with no medically modifiable risk factors.
  
  
  METHODS
  Institutional review board approval or waiver of consent was obtained at each center. This study was HIPAA compliant. From an international multicenter cohort study of 27 125 subjects undergoing coronary computed tomographic (CT) angiography from 12 centers, 5262 patients without known CAD and without modifiable risk factors were identified. CAD severity was defined as none (0%), mild (1%-49%), or obstructive (≥ 50%) on a per-patient, per-vessel, and per-segment basis. CAD presence, extent, and severity were related to incidence of major adverse cardiovascular event (MACE) by using Cox proportional hazards models.
  
  
  RESULTS
  At a mean follow-up of 2.3 years ± 1.2 (standard deviation), MACE occurred in 106 patients. CAD was common for nonobstructive (n = 1452, 27%) and obstructive (n = 629, 12%) CAD. In risk-adjusted analysis, per-patient obstructive CAD (hazard ratio [HR], 6.64; 95% confidence interval [CI]: 3.68, 12.00; P ≤ .001) was related to MACE. MACE was associated with a dose-response relationship to the number of vessels exhibiting obstructive CAD, increasing risk for obstructive one-vessel (HR, 6.11; 95% CI: 3.22, 11.6; P ≤ .001), two-vessel (HR, 5.86; 95% CI: 2.75, 12.5; P ≤ .0001), or three-vessel or left main (HR, 11.69; 95% CI: 5.38, 25.4; P ≤ .001) CAD. The increased hazard for MACE of obstructive disease holds true for symptomatic (HR, 11.9; 95% CI: 4.81, 29.6; P ≤ .001) and asymptomatic (HR, 6.3; 95% CI: 2.4, 16.7; P ≤ .001) patients. No CAD at coronary CT angiography was associated with a low annualized MACE rate: 0.31% versus 2.06% with obstructive disease.
  
  
  CONCLUSIONS
  Among individuals suspected of having CAD but without modifiable risk factors, CAD is common, with significantly increased hazards for MACE and mortality.
authors: Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada. jleipsic@providencehealth.bc.ca
authors: Jonathon
authors: J
authors: Leipsic
authors: Carolyn M
authors: CM
authors: Taylor
authors: Gilat
authors: G
authors: Grunau
authors: Brett G
authors: BG
authors: Heilbron
authors: G B John
authors: GB
authors: Mancini
authors: Stephan
authors: S
authors: Achenbach
authors: Mouaz
authors: M
authors: Al-Mallah
authors: Daniel S
authors: DS
authors: Berman
authors: Matthew J
authors: MJ
authors: Budoff
authors: Filippo
authors: F
authors: Cademartiri
authors: Tracy Q
authors: TQ
authors: Callister
authors: Hyuk-Jae
authors: HJ
authors: Chang
authors: Victor Y
authors: VY
authors: Cheng
authors: Kavitha
authors: K
authors: Chinnaiyan
authors: Benjamin J W
authors: BJ
authors: Chow
authors: Augustin
authors: A
authors: Delago
authors: Martin
authors: M
authors: Hadamitzky
authors: Joerg
authors: J
authors: Hausleiter
authors: Ricardo
authors: R
authors: Cury
authors: Gudrun
authors: G
authors: Feuchtner
authors: Yong-Jin
authors: YJ
authors: Kim
authors: Philipp A
authors: PA
authors: Kaufmann
authors: Fay Y
authors: FY
authors: Lin
authors: Erica
authors: E
authors: Maffei
authors: Gilbert
authors: G
authors: Raff
authors: Leslee J
authors: LJ
authors: Shaw
authors: Todd C
authors: TC
authors: Villines
authors: James K
authors: JK
authors: Min
mesh_terms: D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000235:genetics; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed