Association of Coronary Artery Calcium in Adults Aged 32 to 46 Years With Incident Coronary Heart Disease and Death

Abstract

IMPORTANCE Coronary artery calcium (CAC) is associated with coronary heart disease (CHD) and cardiovascular disease (CVD); however, prognostic data on CAC are limited in younger adults. OBJECTIVE To determine if CAC in adults aged 32 to 46 years is associated with incident clinical CHD, CVD, and all-cause mortality during 12.5 years of follow-up. DESIGN, SETTING, AND PARTICIPANTS The Coronary Artery Risk Development in Young Adults (CARDIA) Study is a prospective community-based study that recruited 5115 black and white participants aged 18 to 30 years from March 25, 1985, to June 7, 1986. The cohort has been under surveillance for 30 years, with CAC measured 15 (n = 3043), 20 (n = 3141), and 25 (n = 3189) years after recruitment. The mean follow-up period for incident events was 12.5 years, from the year 15 computed tomographic scan through August 31, 2014. MAIN OUTCOMES AND MEASURES Incident CHD included fatal or nonfatal myocardial infarction, acute coronary syndrome without myocardial infarction, coronary revascularization, or CHD death. Incident CVD included CHD, stroke, heart failure, and peripheral arterial disease. Death included all causes. The probability of developing CAC by age 32 to 56 years was estimated using clinical risk factors measured 7 years apart between ages 18 and 38 years. RESULTS At year 15 of the study among 3043 participants (mean [SD] age, 40.3 [3.6] years; 1383 men and 1660 women), 309 individuals (10.2%) had CAC, with a geometric mean Agatston score of 21.6 (interquartile range, 17.3–26.8). Participants were followed up for 12.5 years, with 57 incident CHD events and 108 incident CVD events observed. After adjusting for demographics, risk factors, and treatments, those with any CAC experienced a 5-fold increase in CHD events (hazard ratio [HR], 5.0; 95% CI, 2.8–8.7) and 3-fold increase in CVD events (HR, 3.0; 95% CI, 1.9–4.7). Within CAC score strata of 1–19, 20–99, and 100 or more, the HRs for CHD were 2.6 (95% CI, 1.0–5.7), 5.8 (95% CI, 2.6–12.1), and 9.8 (95% CI, 4.5–20.5), respectively. A CAC score of 100 or more had an incidence of 22.4 deaths per 100 participants (HR, 3.7; 95% CI, 1.5–10.0); of the 13 deaths in participants with a CAC score of 100 or more, 10 were adjudicated as CHD events. Risk factors for CVD in early adult life identified those above the median risk for developing CAC and, if applied, in a selective CAC screening strategy could reduce the number of people screened for CAC by 50% and the number imaged needed to find 1 person with CAC from 3.5 to 2.2. CONCLUSIONS AND RELEVANCE The presence of CAC among individuals aged between 32 and 46 years was associated with increased risk of fatal and nonfatal CHD during 12.5 years of follow-up. A CAC score of 100 or more was associated with early death. Adults younger than 50 years with any CAC, even with very low scores, identified on a computed tomographic scan are at elevated risk of clinical CHD, CVD, and death. Selective use of screening for CAC might be considered in individuals with risk factors in ea...

Coronary Artery Calcification (CAC) and Post‐Trial Cardiovascular Events and Mortality Within the Women's Health Initiative (WHI) Estrogen‐Alone Trial

“…In absolute risk, the age‐adjusted CVD rate/1000 PYs for CAC 11 to 100 (11.38) is similar to family history of MI in first‐degree relatives (12.82) and is intermediate between former smokers (8.50) and current smokers (13.74). Our results agree with prior reports showing that presence of any CAC (>0) is associated with increased CVD and mortality among women with a broader age range,14, 15 as well younger adults over 10 to 15 years of follow‐up 16. Among younger adults in the CARDIA (Coronary Artery Risk Development in Young Adults) study, CVD risk was higher with any CAC starting as low as CAC=1 to 19 16…”

“…Finally, while presence and severity of CAC is strongly associated with the overall atherosclerotic plaque burden, it does not quantify noncalcified plaque, and may also represent inflammation or other determinants of tissue calcification 21, 22, 23. In spite of this, our results agree with other studies that have shown that for both men and women, CAC=0 is associated with extremely low risk of CHD over the next 10 to 15 years, and there is a consistent linear relationship between the amount of CAC and the risk of CHD and CVD 16. Additional studies of lower risk populations are needed to validate our findings that CHD and CVD risk are higher with any versus no CAC, even among those with low CAC scores.…”

Intermuscular Adipose Tissue and Subclinical Coronary Artery Calcification in Midlife

“…The present study suggests that higher abdominal IMAT is associated with CAC development which is, in turn, a well-established non-invasive imaging marker for risk of incident CHD and CVD 31,32 . Previous studies that are directly comparable to the present study are few and may have been limited in power 15,16 .…”

The Implication of Coronary Artery Calcium Testing for Cardiovascular Disease Prevention and Diabetes

“…A recent important finding from the CARDIA study is that the presence of any CAC in early adult life (i.e., CAC >0), even after accounting for other risk factors, indicates a higher risk of having a future CHD or CVD event during the next decade [20]. Since the presence of CAC in young adults aged 32 to 46 was relatively rare (~10%), widescreen unselected CAC testing in those less than 45 is not recommended.…”