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Predictors of Coronary Artery Calcium and Long-Term Risks of Death, Myocardial Infarction, and Stroke in Young Adults
Aamir Javaid1, Joshua D Mitchell2, Todd C Villines1
1Division of Cardiovascular Medicine University of Virginia Health Charlottesville VA.
Insights
Coronary artery calcium (CAC) is prevalent in young adults and predicts future heart attacks and major adverse cardiovascular events (MACE). Even mild CAC increases risks, suggesting its utility in guiding clinical decisions for select young individuals.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Coronary artery calcium (CAC) is established for cardiovascular risk stratification in middle-aged and older adults.
- Guidelines recommend further research on CAC performance in low-risk younger populations.
- This study addresses the need for data on CAC in adults aged 30-49.
Purpose of the Study:
- To evaluate the prevalence and prognostic value of coronary artery calcium (CAC) in a large cohort of young adults (30-49 years).
- To assess the association of CAC with myocardial infarction (MI), stroke, major adverse cardiovascular events (MACE), and all-cause mortality.
- To determine if CAC improves risk prediction beyond traditional risk factors in this demographic.
Main Methods:
- A cohort of 13,397 patients aged 30-49 without known cardiovascular disease or malignancy underwent CAC measurement.
- Outcomes including MI, stroke, MACE, and all-cause mortality were assessed over an 11-year follow-up.
- Cox proportional hazard models were used, controlling for baseline risk factors and competing risks.
Main Results:
- A 20.6% prevalence of any CAC was observed in this low-risk young adult cohort.
- CAC was independently predicted by age, male sex, White race, and cardiovascular disease risk factors.
- Any CAC (CAC >0) was associated with a 2.9-fold increased hazard for MI and 1.6-fold for MACE.
- Severe CAC (CAC >100) significantly increased hazards for MI (5.2-fold), MACE (3.1-fold), stroke (1.7-fold), and all-cause mortality (2.1-fold).
- CAC significantly improved the prognostic accuracy for MACE, MI, and all-cause mortality.
Conclusions:
- Coronary artery calcium is prevalent in young, seemingly low-risk adults.
- The presence of CAC, even mild, is linked to significantly higher long-term risks of MACE and MI.
- Severe CAC is associated with increased hazards across all studied outcomes, including mortality.
- CAC may offer clinical utility for risk stratification and decision-making in select young adults.
Abstract:
Background Coronary artery calcium (CAC) is well-validated for cardiovascular disease risk stratification in middle to older-aged adults; however, the 2019 American College of Cardiology/American Heart Association guidelines state that more data are needed regarding the performance of CAC in low-risk younger adults. Methods and Results We measured CAC in 13 397 patients aged 30 to 49 years without known cardiovascular disease or malignancy between 1997 and 2009. Outcomes of myocardial infarction (MI), stroke, major adverse cardiovascular events (MACE; MI, stroke, or cardiovascular death), and all-cause mortality were assessed using Cox proportional hazard models, controlling for baseline risk factors (including atrial fibrillation for stroke and MACE) and the competing risk of death or noncardiac death as appropriate. The cohort (74% men, mean age 44 years, and 76% with ≤1 cardiovascular disease risk factor) had a 20.6% prevalence of any CAC. CAC was independently predicted by age, male sex, White race, and cardiovascular disease risk factors. Over a mean of 11 years of follow-up, the relative adjusted subhazard ratio of CAC >0 was 2.9 for MI and 1.6 for MACE. CAC >100 was associated with significantly increased hazards of MI (adjusted subhazard ratio, 5.2), MACE (adjusted subhazard ratio, 3.1), stroke (adjusted subhazard ratio, 1.7), and all-cause mortality (hazard ratio, 2.1). CAC significantly improved the prognostic accuracy of risk factors for MACE, MI, and all-cause mortality by the likelihood ratio test (P<0.05). Conclusions CAC was prevalent in a large sample of low-risk young adults. Those with any CAC had significantly higher long-term hazards of MACE and MI, while severe CAC increased hazards for all outcomes including death. CAC may have utility for clinical decision-making among select young adults.
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