Prevalence of Coronary Atherosclerosis in Asymptomatic Healthy Subjects: An Intravascular Ultrasound Study of Donor Hearts

Aim: At present, limited in vivo information is available on the prevalence and severity of coronary atherosclerosis in asymptomatic healthy subjects. The aim of this study was to examine the prevalence, extent and severity of coronary atherosclerosis in healthy individuals. Methods: We performed an intravascular ultrasound (IVUS) examination on 198 heart transplant recipients 4 weeks after transplantation. The donor population consisted of 147 men and 51 women (31.4 +/- 11.0 years). The left anterior descending coronary artery was imaged in all patients, and 3 vessel images were obtained for 99 patients. Results: Angiographic appearance was completely normal in 177 of the 198 subjects (89.4%), while atherosclerotic luminal irregularities were observed in the remaining individuals. IVUS revealed that atherosclerotic lesions (defined as intimal thickness >= 0.5 mm at any site) were present in 96 patients (48.5%). The prevalence of coronary atherosclerosis rapidly increased with age (10-19 years, 5.9%; 20-29 years, 31.1%; 30-39 years, 59.0%; 40-49 years, 78.4%). In the diseased subgroup, atherosclerotic lesions were mostly eccentric (92.7%), with maximal intimal thickness of 0.99 +/- 0.42 mm (area stenosis, 32.2 +/- 11.7%). All coronary arteries were predominantly located in the proximal third of each vessel. Donor age, male sex, and hypertension were the determinants of coronary atherosclerosis measured by IVUS examination. As more risk factors were present, the risk of atherosclerosis increased. Conclusion: Coronary atherosclerosis is common in asymptomatic young healthy adults, supporting the need for preventive cardiology in the early stages of life.