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Published on: August 28, 2018
Coronary Artery Calcium for Risk Assessment in Young Adults
Ayman Haq1, Michael D Miedema2
1The Nolan Family Center for Cardiovascular Health, Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 420, Minneapolis, MN, 55414, USA.
Insights
Coronary artery calcium (CAC) scans identify atherosclerotic cardiovascular disease (ASCVD) risk in younger adults. Even with low prevalence, CAC indicates future event risk and aids preventive therapy decisions.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Atherosclerotic cardiovascular disease (ASCVD) risk assessment is crucial, even in younger populations.
- Coronary artery calcium (CAC) scoring is an emerging tool for evaluating subclinical atherosclerosis.
Purpose of the Study:
- To review the prognostic significance of CAC in younger adults.
- To assess the clinical utility of CAC for ASCVD risk stratification in this demographic.
Main Methods:
- Analysis of data from the CARDIA registry (over 3000 young adults).
- Examination of data from the CAC consortium (over 22,000 asymptomatic individuals).
- Longitudinal follow-up to assess ASCVD events and mortality.
Main Results:
- Low CAC prevalence (~10%) in a community sample, but those with CAC showed increased risk over time.
- Higher CAC prevalence (34%) in those screened for clinical indications, with varied mortality rates.
- CAC demonstrated clear prognostic value in younger adults.
Conclusions:
- CAC provides significant prognostic information for ASCVD risk in younger adults.
- CAC can aid clinical decision-making for preventive therapies in select individuals with risk uncertainties.
Purpose Of Review:
To review the prognostic significance and clinical utility of coronary artery calcium (CAC) for risk assessment for atherosclerotic cardiovascular disease (ASCVD) in younger adults.
Recent Findings:
Data from over 3000 young adults (mean age of 40.3 ± 3.6 followed for 12.5 years) in the CARDIA registry found that in an asymptomatic, community representative sample, there was a low prevalence of CAC (~ 10%) but those with CAC had an exponential increase in CAC over time and significantly higher rates of ASCVD events. Alternatively, data from the CAC consortium analyzed 22,346 asymptomatic individuals undergoing CAC for clinical indications (mean age 43.5 ± 4.5 years, followed for 13 ± 4 years) and found a much higher prevalence of CAC at 34% with rates of coronary heart disease mortality that varied significantly according to CAC. In younger adults, CAC provides clear prognostic value and can be considered in select individuals with uncertainties about their ASCVD risk or the benefit of preventive therapies.
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