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Atherosclerosis. 2019 Mar;282:188-195. doi: 10.1016/j.atherosclerosis.2018.11.035. Epub 2018 Dec 1.

Increased burden of coronary artery calcium from elevated blood pressure in low-risk young adults.

Author information

1
Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
2
Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea. Electronic address: yoosoo.chang@samsung.com.
3
Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
4
Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
5
Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea. Electronic address: sh703.yoo@samsung.com.

Abstract

BACKGROUND AND AIMS:

The relationship between blood pressure (BP) levels given in the new hypertension guidelines by the American College of Cardiology and the American Heart Association (ACC/AHA) and subclinical coronary atherosclerosis in low-risk young adults is unknown. We evaluated the association between the new BP categories and coronary artery calcium (CAC) in low-risk, young and middle-aged adults.

METHODS:

We performed a cross-sectional study of 96,166 Koreans who underwent a health examination including cardiac tomography estimation of CAC scores in 2012-2017. BP categories were defined according to the 2017 ACC/AHA guidelines. We used Poisson regression models with robust variance to calculate prevalence ratios (PRs) with 95% confidence intervals (CIs) for prevalent CAC >0.

RESULTS:

Overall, higher BP categories were associated with higher CAC scores in both young (aged 20-39) and middle-aged people (aged 40 years or more). After adjusting for possible confounders, including traditional cardiovascular disease (CVD) risk factors, the multivariable-adjusted PRs (95% CI) for prevalent CAC, comparing elevated BP and stage 1 and 2 hypertension to normal BP, were 1.27 (1.08-1.49), 1.45 (1.28-1.63), and 2.02 (1.67-2.43), respectively, among those aged 20-39 years and 1.25 (1.15-1.36), 1.29 (1.23-1.35), and 1.46 (1.36-1.57), respectively, among those aged ≥40 years. This association was also evident in those with a 10-year CVD risk of <10%.

CONCLUSIONS:

Higher BP categories were positively associated with prevalent CAC, and that association began in the elevated BP category, even in a young and low-risk population.

KEYWORDS:

Atherosclerosis; Blood pressure; Coronary artery calcium; Hypertension; Young adults

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