Subclinical Coronary Atherosclerosis and Myocardial Infarction Risk: Evidence From a Danish CT Cohort

Larsen and colleagues studied 10,003 asymptomatic Danish adults older than 40 years who underwent coronary CT angiography. Women had less subclinical coronary atherosclerosis than men across age groups and risk-factor profiles. During a median six years of follow-up, obstructive subclinical disease was associated with a higher risk of myocardial infarction in both sexes.

The adjusted association with myocardial infarction was estimated at 4.1 in women and 12 in men for obstructive versus no subclinical coronary atherosclerosis. However, the study did not demonstrate a statistically significant sex interaction for the myocardial-infarction association. The message is therefore not that obstructive disease is benign in women, but that plaque burden and risk interpretation may require sex-aware context.

This is an observational cohort study in a Danish population. It cannot establish causation, determine the best screening strategy, or directly dictate testing pathways in Iraq or elsewhere. Coronary CT use should follow symptoms, pre-test probability, guideline recommendations, local expertise, and shared clinical judgement.

Editorial note: this is a professional educational summary, not a recommendation for indiscriminate coronary CT screening.