ORIGINAL PAPER Non-invasive assessments reveal that more than half of randomly selected middle-aged individuals have evidence of subclinical atherosclerosis: a DanRisk substudy Ida S. Bjerrum • Niels P. Rønnow Sand • Mikael K. Poulsen • Bjarne L. Nørgaard • Johannes J. Sidelmann • Allan Johansen • Hans Mickley • Axel C. P. Diederichsen Received: 21 February 2012 / Accepted: 27 June 2012 / Published online: 5 July 2012 Ó Springer Science+Business Media, B.V. 2012 Abstract Screening of the general population for sub- clinical atherosclerosis is controversial. We assessed the prevalence of subclinical atherosclerosis in healthy middle- aged individuals by 4 non-invasive modalities. In 277 randomly selected males (n = 121) and females (n = 156), aged 50 or 60 years, without known cardiovascular disease or diabetes, intima-media thickness/presence of carotid plaques by ultrasound; coronary artery calcification (CAC) by non-contrast enhanced cardiac CT; occurrence of peripheral artery disease (PAD) by ankle brachial index (ABI), and vascular leakage by urine albumin creatinine ratio (ACR), were evaluated. Traditional risk factors were obtained and HeartScore was calculated. A total of 56 % had morphological signs of atherosclerosis in one of the vascular territories; 41 % had CAC and 31 % a carotid plaque. Among individuals with atherosclerosis, 28 % had lesions in both vascular territories. Subclinical atheroscle- rosis was significantly more frequent in older males. Signs of PAD and microalbuminuria were very uncommon and detected in only 1 % of the entire population. No associ- ation was found between morphological signs of subclini- cal atherosclerosis and ABI or ACR. More than half of randomly selected apparently healthy middle aged indi- viduals had subclinical atherosclerosis located in the cor- onary or carotid arteries. Keywords Subclinical atherosclerosis Á General population Á Coronary artery calcium Á Carotid IMT Introduction Cardiovascular disease (CVD) has decreased noticeably during the past 2 decades due to a healthier lifestyle and better treatment regimens. However, CVD is still a major cause of death [1]. In addition, resources associated with diagnosis and treatment of CVD consume a large amount of the total health care expenditures. Therefore the effi- ciency of various CVD risk stratification algorithms have gained increasing attention [2, 3]. In all subjects at risk of CVD lifestyle changes are recommended, whereas subjects at high risk should be considered also for pharmacological prophylaxis [4, 5]. As the majority of cardiovascular seri- ous events actually occur in subjects at low or intermediate risk [6, 7], and population-based risk algorithms suffer from low individual predictive values, there is a need for I. S. Bjerrum Á N. P. R. Sand (&) Department of Cardiology, SVS Esbjerg, 6700 Esbjerg, Denmark e-mail: idabjerrum@gmail.com N. P. R. Sand Á B. L. Nørgaard Á A. C. P. Diederichsen Institute of Regional Health Services Research, University of Southern Denmark, Copenhagen, Denmark M. K. Poulsen Á H. Mickley Á A. C. P. Diederichsen Department of Cardiology, Odense University Hospital, Copenhagen, Denmark B. L. Nørgaard Department of Cardiology, Sygehus Lillebælt Vejle, Copenhagen, Denmark J. J. Sidelmann Unit for Thrombosis Research, University of Southern Denmark, Copenhagen, Denmark J. J. Sidelmann Department of Clinical Biochemistry, SVS Esbjerg, Esbjerg, Denmark A. Johansen Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark 123 Int J Cardiovasc Imaging (2013) 29:301–308 DOI 10.1007/s10554-012-0091-8