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Published on: August 28, 2018
Distribution of Coronary Artery Calcium by Age, Sex, and Race Among Patients 30-45 Years Old
Aamir Javaid1, Zeina A Dardari2, Joshua D Mitchell3
1Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
Insights
Coronary artery calcium (CAC) prevalence varies by age, sex, and race in adults under 45. New percentiles help interpret CAC scores for young adults, aiding cardiovascular risk assessment.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Coronary artery calcium (CAC) is a validated measure of atherosclerotic burden for risk stratification in middle-aged and older adults.
- Limited data exists on CAC in younger adults (<45 years), with no established calculators for age-, sex-, and race-based percentiles.
Purpose of the Study:
- To determine the probability of CAC >0 in U.S. adults aged 30-45 years.
- To develop age-, sex-, and race-specific percentiles for CAC distributions in this demographic.
Main Methods:
- Harmonized data from three cohorts (CARDIA, CAC Consortium, Walter Reed Cohort) involving 19,725 asymptomatic individuals (30-45 years) without known atherosclerotic cardiovascular disease.
- Weighted equal contribution from each cohort.
- Nonparametric techniques used to estimate CAC >0 probability and percentiles.
Main Results:
- Prevalence of CAC >0 was 26% (White males), 16% (Black males), 10% (White females), and 7% (Black females).
- CAC >0 placed all females above the 90th percentile.
- White males reached the 90th percentile at age 34, Black males at age 37.
- An interactive webpage was developed for percentile calculation.
Conclusions:
- The probability of CAC >0 varies significantly by age, sex, and race in young U.S. adults (30-45 years) without symptomatic cardiovascular disease.
- Estimated percentiles facilitate the interpretation of CAC scores relative to peers.
- These percentiles can be incorporated into CAC score reporting for improved risk assessment in younger populations.
Background:
Coronary artery calcium (CAC) is a measure of atherosclerotic burden and is well-validated for risk stratification in middle- to older-aged adults. Few studies have investigated CAC in younger adults, and there is no calculator for determining age-, sex-, and race-based percentiles among individuals aged <45 years.
Objectives:
The purpose of this study was to determine the probability of CAC >0 and develop age-sex-race percentiles for U.S. adults aged 30-45 years.
Methods:
We harmonized 3 datasets-CARDIA (Coronary Artery Risk Development in Young Adults), the CAC Consortium, and the Walter Reed Cohort-to study CAC in 19,725 asymptomatic Black and White individuals aged 30-45 years without known atherosclerotic cardiovascular disease. After weighting each cohort equally, the probability of CAC >0 and age-sex-race percentiles of CAC distributions were estimated using nonparametric techniques.
Results:
The prevalence of CAC >0 was 26% among White males, 16% among Black males, 10% among White females, and 7% among Black females. CAC >0 automatically placed all females at >90th percentile. CAC >0 placed White males at the 90th percentile at age 34 years compared with Black males at age 37 years. An interactive webpage allows one to enter an age, sex, race, and CAC score to obtain the corresponding estimated percentile.
Conclusions:
In a large cohort of U.S. adults aged 30-45 years without symptomatic atherosclerotic cardiovascular disease, the probability of CAC >0 varied by age, sex, and race. Estimated percentiles may help interpretation of CAC scores among young adults relative to their age-sex-race matched peers and can henceforth be included in CAC score reporting.
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