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JAMA Netw Open. 2019 Jul 3;2(7):e197440. doi: 10.1001/jamanetworkopen.2019.7440.

Association of Coronary Artery Calcium With Long-term, Cause-Specific Mortality Among Young Adults.

Author information

1
Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
2
Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
3
Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida.
4
Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
5
Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
6
Department of Radiology, Weill Cornell Medical College, New York, New York.
7
Department of Cardiac Imaging, The Princeton Longevity Center, Princeton, New Jersey.
8
Department of Medicine, Mount Sinai, New York, New York.
9
Department of Imaging, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California.
10
Department of Medicine, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California.
11
Los Angeles BioMedical Research Institute, Harbor University of California Los Angeles Medical Center, Torrance.

Abstract

Importance:

The level of coronary artery calcium (CAC) can effectively stratify cardiovascular risk in middle-aged and older adults, but its utility for young adults is unclear.

Objectives:

To determine the prevalence of CAC in adults aged 30 to 49 years and the subsequent association of CAC with coronary heart disease (CHD), cardiovascular disease (CVD), and all-cause mortality.

Design, Setting, and Participants:

A multicenter retrospective cohort study was conducted among 22 346 individuals from the CAC Consortium who underwent CAC testing (baseline examination, 1991-2010, with follow-up through June 30, 2014; CAC quantified using nonconrast, cardiac-gated computed tomography scans) for clinical indications and were followed up for cause-specific mortality. Participants were free of clinical CVD at baseline. Statistical analysis was performed from June 1, 2017, to May 31, 2018.

Main Outcomes and Measures:

The prevalence of CAC and the subsequent rates of CHD, CVD, and all-cause mortality. Competing risks regression modeling was used to calculate multivariable-adjusted subdistribution hazard ratios for CHD and CVD mortality.

Results:

The sample of 22 346 participants (25.0% women and 75.0% men; mean [SD] age, 43.5 [4.5] years) had a high prevalence of hyperlipidemia (49.6%) and family history of CHD (49.3%) but a low prevalence of current smoking (11.0%) and diabetes (3.9%). The prevalence of any CAC was 34.4%, with 7.2% having a CAC score of more than 100. During follow-up (mean [SD], 12.7 [4.0] years), there were 40 deaths related to CHD, 84 deaths related to CVD, and 298 total deaths. A total of 27 deaths related to CHD (67.5%) occurred among individuals with CAC at baseline. The CHD mortality rate per 1000 person-years was 10-fold higher among those with a CAC score of more than 100 (0.69; 95% CI, 0.41-1.16) compared with those with a CAC score of 0 (0.07; 95% CI, 0.04-0.12). After multivariable adjustment, those with a CAC score of more than 100 had a significantly increased risk of CHD (subdistribution hazard ratio, 5.6; 95% CI, 2.5-12.7), CVD (subdistribution hazard ratio, 3.3; 95% CI, 1.8-6.2), and all-cause mortality (hazard ratio, 2.6; 95% CI, 1.9-3.6) compared with those with a CAC score of 0.

Conclusions and Relevance:

In a large sample of young adults undergoing CAC testing for clinical indications, 34.4% had CAC, and those with elevated CAC scores had significantly higher rates of CHD and CVD mortality. Coronary artery calcium may have potential utility for clinical decision-making among select young adults at elevated risk of cardiovascular disease.

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