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Coronary Artery Calcium Scoring in Young Adults: Evidence and Challenges
Marwan Saad1,2, Naga Venkata Pothineni3, Joseph Thomas4
1Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, 72205, USA. mssaad@uams.edu.
Insights
Coronary artery calcium (CAC) scoring shows value in assessing coronary artery disease (CAD) risk in young adults. However, widespread screening faces challenges, necessitating better risk prediction tools for early detection.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Coronary artery disease (CAD) risk assessment in young adults is crucial.
- Coronary artery calcium (CAC) scoring is an emerging tool for evaluating subclinical atherosclerosis.
Purpose of the Study:
- To review the evidence and challenges of using CAC scoring for CAD screening in young adults.
- To evaluate the utility of CAC scoring in identifying at-risk individuals early in life.
Main Methods:
- Review of cohort studies, including the Coronary Artery Risk Development in Young Adults (CARDIA) study.
- Analysis of CAC score distribution and its association with coronary events in young adults.
Main Results:
- Any CAC in young adults is linked to increased coronary event risk compared to zero CAC.
- Higher CAC scores correlate with incrementally higher event risks.
- A significant proportion (70%) of screened individuals had zero CAC at age 56, indicating potential challenges with current thresholds.
Conclusions:
- CAC scoring is valuable for CAD risk stratification in young adults.
- Current CAC score cutoffs may be 'falsely reassuring' for some individuals.
- Developing predictive tools for identifying high-risk individuals for CAC screening is essential to improve efficiency.
Purpose Of Review:
This review aims to summarize the evidence and challenges of coronary artery calcium (CAC) scoring as a screening tool for coronary artery disease (CAD) in young adults.
Recent Findings:
Several cohort studies have highlighted the value of CAC scoring in CAD risk assessment in young adults. The largest study to date is the Coronary Artery Risk Development in Young Adults (CARDIA) study. The study examined patients at 18-30 years of age and demonstrated that the presence of any degree of CAC was associated with a higher risk of coronary events compared to zero CAC, with an incremental increase in the risk of events with higher scores. However, it is important to note that 70% of patients screened had CAC = 0 at the age of 56. Despite the evidence that higher CAC score cutoff used in guidelines for predicting cardiovascular risk may be "falsely reassuring," however, mass screening of young adults using CAC score may be challenging. The development of prediction tools and scoring systems to identify patients at higher risk of developing CAC based on known CAD risk factors may help reduce the number needed to screen to detect patients with positive CAC.
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