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Defining Demographic-specific Coronary Artery Calcium Percentiles in the Population Aged ≥75: The ARIC Study and MESA
Frances M Wang1, Miguel Cainzos-Achirica1,2, Shoshana H Ballew1
1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (F.M.W., M.C.-A., S.H.B., J.C., W.S.P., M.J.B., K.M.).
Insights
Current guidelines for coronary artery calcium (CAC) scores lack data for adults over 75. This study establishes new demographic-specific CAC percentiles for this age group, finding most older adults exceed the high-risk threshold.
Area of Science:
- Cardiology
- Geriatric Medicine
- Preventive Cardiology
Background:
- Current clinical guidelines for atherosclerotic cardiovascular disease (ASCVD) preventive therapy rely on coronary artery calcium (CAC) scores of 100 Agatston Units or demographic-specific 75th percentile thresholds.
- Existing data informing CAC percentiles for adults aged 75-85 years are limited, with scarce information for individuals aged 85 and older.
- There is a need for updated, population-specific CAC distributions and percentiles in older adults to accurately guide ASCVD risk assessment.
Purpose of the Study:
- To characterize the distribution of coronary artery calcium (CAC) in adults aged 75 years and older.
- To establish demographic-specific (sex and race) CAC percentiles for individuals aged 75 years and older.
- To provide updated data for interpreting CAC scores in the geriatric population for ASCVD risk stratification.
Main Methods:
- Analysis of 2886 participants aged ≥75 years without clinical coronary heart disease from the ARIC and MESA studies.
- Estimation of CAC prevalence (>0) and sex- and race-specific CAC percentiles using nonparametric locally weighted regression and pooled residual ranking.
- Inclusion of data from ARIC visit 7 (2018-2019) and MESA visit 5 (2010-2011).
Main Results:
- The prevalence of zero CAC was 11% in community-dwelling adults aged ≥75 years.
- Regardless of sex and race, 62.5% of participants had CAC >100 Agatston Units, suggesting most older adults would be classified as high risk under current thresholds.
- CAC scores increased with age, with approximately 95% of participants aged ≥90 years having detectable CAC across subgroups.
- The 75th percentile CAC scores were higher for Black older adults, particularly females, compared to existing thresholds.
Conclusions:
- In adults aged ≥75 years free of clinical coronary heart disease, a CAC score >100 Agatston Units would classify the majority as high risk for ASCVD.
- Demographic-specific CAC percentiles derived from this study are crucial for accurate CAC interpretation in the ≥75 years population.
- Updated CAC percentiles are essential for refining ASCVD risk assessment and preventive therapy decisions in older adults.
Background:
Current clinical guidelines recommend a coronary artery calcium (CAC) score of 100 Agatston Units or demographic-specific 75th percentile as high-risk thresholds for guiding atherosclerotic cardiovascular disease preventive therapy. Meanwhile, low CAC can help derisk individuals who may safely defer statin therapy. However, limited data from the early 2000s, including just 208 older Black individuals, inform CAC percentiles for adults aged 75 to 85 years, and none have been established in adults aged ≥85 years. This study aims to characterize the distribution of CAC and establish demographic-specific CAC percentiles in the population aged ≥75 years.
Methods:
We assessed 2886 participants aged ≥75 years without clinical coronary heart disease from the ARIC study (Atherosclerosis Risk in Communities) visit 7 (2018-2019; n=2217) and the MESA (Multi-Ethnic Study of Atherosclerosis) visit 5 (2010-2011; n=669). Prevalence of any CAC >0 and sex- and race-specific CAC percentiles across age were estimated nonparametrically with locally weighted regression models and pooled residual ranking.
Results:
The median age was 80 (interquartile interval, 77-83) years, and 60% were female. The prevalence of zero CAC was lowest in White males (4%), followed by Black males (13%), White females (14%), and highest in Black females (18%). Regardless of sex and race, most participants had CAC>100 (62.5%). CAC scores increased with age, with CAC identified in ≈95% of participants aged ≥90 years across sex-race subgroups. The 75th percentile corresponded to higher CAC scores for Black older adults (n=741), especially females, than currently used thresholds.
Conclusions:
In community-dwelling adults aged ≥75 years free of clinical coronary heart disease, the prevalence of zero CAC was 11%, and CAC >100 as a threshold for high ASCVD risk would categorize most of this older population as high risk. Demographic-specific CAC percentiles from this study are a valuable tool for interpreting CAC in the population aged ≥75 years.
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