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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

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



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.


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.


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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