Coronary Atherosclerosis in an Asymptomatic U.S. Population: Miami Heart Study at Baptist Health South Florida

Khurram Nasir, Miguel Cainzos-Achirica, Javier Valero-Elizondo, Shozab S. Ali, Ruby Havistin, Suvasini Lakshman, Michael J. Blaha, Ron Blankstein, Michael D. Shapiro, Lara Arias, Anshul Saxena, Theodore Feldman, Matthew J. Budoff, Jack A. Ziffer, Jonathan Fialkow, Ricardo C. Cury

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


BACKGROUND: The burden of total coronary plaque, plaque subtypes, and high-risk plaque features was unknown in asymptomatic individuals from the general U.S. primary prevention population.

OBJECTIVES: In a large, asymptomatic U.S. cohort evaluated using coronary computed tomography angiography (CCTA), we aimed to assess the burden of total coronary plaque, plaque subtypes, and high-risk plaque features; the interplay between CCTA findings and coronary artery calcium (CAC) scores; and identify independent predictors of coronary plaque.

METHODS: Cross-sectional analysis in the MiHeart (Miami Heart Study), a cohort of 2,359 asymptomatic individuals from the Greater Miami Area (mean age 53 years, 50% women, 47% Hispanic/Latino, 43% non-Hispanic White). We estimated the burden of CAC (=0, >0 to <100, ≥100), CCTA-based plaque features (any plaque, stenosis ≥50%, ≥70%, high-risk features), and their interplay.

RESULTS: Overall, 58% participants had CAC = 0, 28% CAC >0 to <100, and 13% CAC ≥100. A total of 49% participants had plaque on the CCTA, including 16% among those with CAC = 0. Overall, 6% participants had coronary stenosis ≥50% (12% among those with coronary plaque), 1.8% had stenosis ≥70% (3.7% among those with plaque), and 7% had at least 1 coronary plaque with ≥1 high-risk feature (13.8% among those with plaque). Only 0.8% participants with CAC = 0 had stenosis ≥50%, 0.1% stenosis ≥70%, and 2.3% plaque with high-risk features. In logistic regression models, independent predictors of coronary plaque and high-risk plaque were older age, male sex, tobacco use, diabetes, overweight, and obesity. Male sex, overweight, and obesity were independent predictors of plaque if CAC = 0.

CONCLUSIONS: The Miami Heart Study confirms substantial prevalence of coronary plaque in asymptomatic individuals. Overall, 49% of participants had coronary plaque, 6% had stenosis ≥50%, and 7% had plaques with at least 1 high-risk feature. These proportions were 16%, 0.8%, and 2.3%, respectively, among those with CAC = 0. Longitudinal follow-up will shed further light on the prognostic implications of these findings in asymptomatic individuals.

Original languageEnglish (US)
Pages (from-to)1604-1618
Number of pages15
JournalJACC: Cardiovascular Imaging
Issue number9
StatePublished - Sep 2022


  • atherosclerosis
  • computed tomography
  • coronary artery calcium
  • epidemiology
  • subclinical
  • Obesity
  • Predictive Value of Tests
  • Cross-Sectional Studies
  • Constriction, Pathologic
  • Humans
  • Middle Aged
  • Risk Factors
  • Male
  • Plaque, Atherosclerotic
  • Overweight
  • Coronary Artery Disease/diagnostic imaging
  • Female
  • Protestantism
  • Florida/epidemiology
  • Coronary Angiography/methods

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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