Coronary Artery Calcium From Early Adulthood to Middle Age and Left Ventricular Structure and Function
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Guilherme S Yared1, Henrique T Moreira1,2, Bharath Ambale-Venkatesh1
1Division of Cardiology, Johns Hopkins University, Baltimore, MD (G.S.Y., H.T.M., B.A.-V., H.D.V., C.C.N., M.R.O., J.A.C.L.).
Insights
Coronary artery calcium (CAC) in middle age is linked to increased left ventricular (LV) mass and poorer diastolic function. Maintaining a CAC-free status from young adulthood correlates with better LV function later in life.
Area of Science:
- Cardiology
- Radiology
- Public Health
Background:
- The association between coronary artery calcium (CAC) and adverse cardiac remodeling is not fully understood.
- Investigating CAC in middle age and its changes over time is crucial for understanding long-term cardiac health.
Purpose of the Study:
- To examine the relationship between CAC in middle age and left ventricular (LV) function.
- To assess how changes in CAC from early adulthood to middle age impact LV function.
Main Methods:
- Utilized computed tomography (CT) to measure CAC scores in participants of the CARDIA study at year-15 and year-25 examinations.
- Assessed LV structure and function using echocardiography at year-25.
- Analyzed CAC as a continuous, log-transformed variable and evaluated the change in CAC over the follow-up period.
Main Results:
- Higher CAC scores in middle age were associated with increased LV mass, LV end-diastolic volume, LV end-systolic volume, left atrial volume, and a higher E/e' ratio, indicating impaired diastolic function.
- A greater increase in CAC score from early adulthood to middle age was independently linked to a higher LV mass index in Black individuals, but not in White individuals.
Conclusions:
- Elevated CAC in middle age is associated with adverse cardiac remodeling, including increased LV mass and volumes, and worsened diastolic function.
- Individuals who remain free of CAC from young adulthood to middle age exhibit better LV function.
- The rate of CAC progression is a significant predictor of LV mass index, particularly in Black populations.
Abstract:
Background The relationship of coronary artery calcium (CAC) with adverse cardiac remodeling is not well established. We aimed to study the association of CAC in middle age and change in CAC from early adulthood to middle age with left ventricular (LV) function. Methods CAC score was measured by computed tomography at CARDIA study (Coronary Artery Risk Development in Young Adults) year-15 examination and at year-25 examination (Y25) in 3043 and 3189 participants, respectively. CAC score was assessed as a continuous variable and log-transformed to account for nonlinearity. Change in CAC from year-15 examination to Y25 was evaluated as the absolute difference of log-transformed CAC from year-15 examination to Y25. LV structure and function were evaluated by echocardiography at Y25. Results At Y25, mean age was 50.1±3.6 years, 56.6% women, 52.4% black. In the multivariable analysis at Y25, higher CAC was related to higher LV mass (β=1.218; adjusted P=0.007), higher LV end-diastolic volume (β=0.811; adjusted P=0.007), higher LV end-systolic volume (β=0.350; adjusted P=0.048), higher left atrial volume (β=0.214; adjusted P=0.009), and higher E/e' ratio (β=0.059; adjusted P=0.014). CAC was measured at both year-15 examination and Y25 in 2449 individuals. Higher change in CAC score during follow-up was independently related to higher LV mass index in blacks (β=4.789; adjusted P<0.001), but not in whites (β=1.051; adjusted P=0.283). Conclusions Higher CAC in middle age is associated with higher LV mass and volumes and worse LV diastolic function. Being free of CAC from young adulthood to middle age correlates to better LV function at middle age. Higher change in CAC score during follow-up is independently related to higher LV mass index in blacks.
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