Increased burden of coronary artery calcium from elevated blood pressure in low-risk young adults
Jeonggyu Kang1, Yoosoo Chang2, Seolhye Kim1
1Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Insights
Higher blood pressure (BP) categories, even elevated BP, are linked to coronary artery calcium (CAC) in young adults. This association exists even in individuals with low cardiovascular disease (CVD) risk.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- The 2017 ACC/AHA hypertension guidelines classify blood pressure (BP) into new categories.
- The association between these new BP categories and subclinical coronary atherosclerosis, specifically coronary artery calcium (CAC), in low-risk young adults remains unclear.
- Subclinical coronary atherosclerosis is an early indicator of cardiovascular disease (CVD).
Purpose of the Study:
- To evaluate the association between the new ACC/AHA BP categories and prevalent CAC in a large cohort of low-risk young and middle-aged adults.
- To determine if this association exists even in individuals with a low estimated 10-year CVD risk.
Main Methods:
- A cross-sectional study was conducted on 96,166 Korean adults who underwent health examinations including cardiac computed tomography (CT) for CAC scoring between 2012 and 2017.
- Blood pressure categories were defined based on the 2017 ACC/AHA guidelines.
- Poisson regression models with robust variance were used to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs) for prevalent CAC >0.
Main Results:
- Higher BP categories were significantly associated with higher CAC scores in both young (20-39 years) and middle-aged (≥40 years) adults.
- After adjusting for confounders, elevated BP, stage 1 hypertension, and stage 2 hypertension were associated with increased odds of prevalent CAC compared to normal BP.
- These associations were observed even in individuals with a 10-year CVD risk of less than 10%.
Conclusions:
- Higher blood pressure categories are positively associated with prevalent coronary artery calcium.
- This association begins at the elevated blood pressure category.
- The link between elevated BP and subclinical coronary atherosclerosis is present even in young, low-risk populations.
Background And Aims:
The relationship between blood pressure (BP) levels given in the new hypertension guidelines by the American College of Cardiology and the American Heart Association (ACC/AHA) and subclinical coronary atherosclerosis in low-risk young adults is unknown. We evaluated the association between the new BP categories and coronary artery calcium (CAC) in low-risk, young and middle-aged adults.
Methods:
We performed a cross-sectional study of 96,166 Koreans who underwent a health examination including cardiac tomography estimation of CAC scores in 2012-2017. BP categories were defined according to the 2017 ACC/AHA guidelines. We used Poisson regression models with robust variance to calculate prevalence ratios (PRs) with 95% confidence intervals (CIs) for prevalent CAC >0.
Results:
Overall, higher BP categories were associated with higher CAC scores in both young (aged 20-39) and middle-aged people (aged 40 years or more). After adjusting for possible confounders, including traditional cardiovascular disease (CVD) risk factors, the multivariable-adjusted PRs (95% CI) for prevalent CAC, comparing elevated BP and stage 1 and 2 hypertension to normal BP, were 1.27 (1.08-1.49), 1.45 (1.28-1.63), and 2.02 (1.67-2.43), respectively, among those aged 20-39 years and 1.25 (1.15-1.36), 1.29 (1.23-1.35), and 1.46 (1.36-1.57), respectively, among those aged ≥40 years. This association was also evident in those with a 10-year CVD risk of <10%.
Conclusions:
Higher BP categories were positively associated with prevalent CAC, and that association began in the elevated BP category, even in a young and low-risk population.
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