Age- and Sex-Specific Distribution and Reference Values of Coronary Artery Calcium in a Large Asymptomatic Japanese
Hidenobu Takagi1,2, Masaharu Hirano3, Takashi Asano4
1Department of Advanced Radiological Imaging Collaborative Research Tohoku University Sendai Japan.
Insights
This study establishes crucial age- and sex-specific coronary artery calcium (CAC) reference values for Japanese adults. These findings highlight the inappropriateness of using Western-derived thresholds for CAC scoring in Japan.
Area of Science:
- Cardiovascular Imaging
- Public Health
- Medical Statistics
Background:
- Coronary artery calcium (CAC) scoring is vital for cardiovascular risk stratification.
- Existing CAC reference data in Japan is lacking, hindering accurate clinical application.
- Western-derived CAC thresholds are unsuitable for the Japanese population due to ethnic variations.
Purpose of the Study:
- To establish the first comprehensive, age- and sex-specific coronary artery calcium reference values for a healthy Japanese population.
- To provide a basis for appropriate CAC scoring and risk stratification in Japan.
Main Methods:
- Retrospective analysis of 4891 asymptomatic Japanese adults.
- Data included individuals without a history of atherosclerotic cardiovascular disease or diabetes.
- Nonparametric regression modeling was used to generate age- and sex-specific CAC percentile curves.
Main Results:
- Men showed a higher CAC burden than women, with scores increasing with age in both sexes.
- CAC progression patterns differed between men (concave down) and women (concave up).
- The Japanese cohort exhibited a significantly lower CAC burden compared to White participants in the Multi-Ethnic Study of Atherosclerosis (MESA) data.
Conclusions:
- This study presents the first large-scale, age- and sex-specific CAC reference values for a healthy Japanese population.
- The developed percentile curves serve as a practical tool for clinicians to assess patient CAC burden relative to peers.
- Utilizing population-specific thresholds is essential for accurate cardiovascular risk stratification in Japan.
Background:
The clinical use of coronary artery calcium (CAC) scoring for risk stratification in Japan is limited by the absence of population-specific reference data, as applying Western-derived thresholds is inappropriate because of known ethnic variations. This study aimed to establish the first comprehensive, age- and sex-specific CAC reference values for a healthy Japanese population.
Methods:
In this single-center retrospective study, we analyzed data from 4891 asymptomatic Japanese adults (63.2% men; median age, 58 years) without a history of atherosclerotic cardiovascular disease or diabetes. Age- and sex-specific CAC percentile curves were generated using nonparametric regression modeling.
Results:
Men exhibited a higher CAC burden than women, with scores increasing with age in both sexes. The relationship between detectable CAC (CAC >0) and age was nonlinear: concave down for men and concave up for women, indicating different progression patterns. Compared with MESA (Multi-Ethnic Study of Atherosclerosis) data, the Japanese cohort had a markedly lower CAC burden than White participants and systematically lower scores than Chinese American women.
Conclusions:
This study provides the first large-scale, age- and sex-specific CAC reference values for a healthy Japanese population. The generated percentile curves offer a practical tool for clinicians to immediately assess a patient's CAC burden relative to their peers, underscoring that using foreign-derived thresholds is inappropriate for risk stratification in Japan.
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