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Multicenter Study
. 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

Michael D Miedema  1 , Zeina A Dardari  2 , Khurram Nasir  3 , Ron Blankstein  4   5 , Thomas Knickelbine  1 , Sandra Oberembt  1 , Leslee Shaw  6 , John Rumberger  7 , Erin D Michos  2 , Alan Rozanski  8 , Daniel S Berman  9   10 , Matthew J Budoff  11 , Michael J Blaha  2
Affiliations
Multicenter Study

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

Michael D Miedema et al. JAMA Netw Open. .

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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Conflict of interest statement

Conflict of Interest Disclosures: Dr Blankstein reported receiving grants from Astellas Inc and grants and personal fees from Amgen Inc outside the submitted work and serving on the board of directors for the Society of Cardiovascular Computed Tomography and the board of directors for the American Society of Preventive Cardiology. Dr Budoff reported receiving grants from General Electric during the conduct of the study. Dr Blaha reported receiving grants and personal fees from Amgen; grants from Sanofi and the American Heart Association; and personal fees from Novo Nordisk, Bayer, and Novartis outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Prevalence of Coronary Artery Calcium (CAC) and Subsequent Rates of Coronary Heart Disease (CHD), Cardiovascular Disease (CVD), and All-Cause Mortality Among Young Adults
A, Prevalence of CAC in 4544 asymptomatic individuals aged 30 to 39 years and 17 802 individuals aged 40 to 49 years enrolled in the CAC Consortium stratified by baseline CAC. B, Subsequent rates of CHD, CVD, and all-cause mortality. The CAC prevalence was categorized according to Agatston scores.
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References

    1. Stone NJ, Robinson JG, Lichtenstein AH, et al. ; American College of Cardiology/American Heart Association Task Force on Practice Guidelines . 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25, pt B):-. doi:10.1016/j.jacc.2013.11.002 - DOI - PubMed
    1. Bibbins-Domingo K, Grossman DC, Curry SJ, et al. ; US Preventive Services Task Force . Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016;316(19):1997-2007. doi:10.1001/jama.2016.15450 - DOI - PubMed
    1. Bibbins-Domingo K; US Preventive Services Task Force . Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(12):836-845. doi:10.7326/M16-0577 - DOI - PubMed
    1. Whelton PK, Carey RM, Aronow WS, et al. . 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269-1324. doi:10.1161/HYP.0000000000000066 - DOI - PubMed
    1. Singh A, Collins BL, Gupta A, et al. . Cardiovascular risk and statin eligibility of young adults after an MI: Partners YOUNG-MI Registry. J Am Coll Cardiol. 2018;71(3):292-302. doi:10.1016/j.jacc.2017.11.007 - DOI - PMC - PubMed

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