Any degree of coronary artery calcium (CAC) detected by computed tomography (CT) imaging in asymptomatic adults between the ages of 30 and 45 is associated with higher cardiovascular risk, according to a pooled analysis of three studies.
For women in this age group, any CAC detected places them above the 90th percentile of cardiovascular risk. White men reach the 90th percentile when CAC is detected at age 34 years, as do Black men in whom CAC is detected at age 37.
Aamir Javaid, BS, from the University of Virginia School of Medicine, and colleagues reported these findings in a manuscript published online Monday and in the May 17 issue of the Journal of the American College of Cardiology.
The authors analyzed three datasets – CARDIA (Coronary Artery Risk Development in Young Adults), the CAC Consortium and the Walter Reed Cohort – to study CAC in 19,725 asymptomatic Black and white individuals aged 30-45 years without known atherosclerotic cardiovascular disease. For subjects with multiple CAC examinations, the authors used the earliest examination available. CAC scoring was performed on all individuals based on the Agatston method.
Individuals were classified based on the presence or absence of calcium and further subdivided into CAC score groups of 0 (none), 1-10 (low), 11-100 (moderate) and >100 (high).
After weighting each cohort equally, the probability of CAC >0 and age-sex-race percentiles of CAC distributions were estimated using nonparametric techniques. The authors also created an interactive percentile calculator on a public webpage with the same design as the Multi-Ethnic Study of Atherosclerosis (MESA) percentile calculator, which allows one to enter an age, sex, and race to obtain an estimated probability of CAC >0 and corresponding estimated 75th, 90th, 95th, and 97.5th CAC percentiles.
The pooled cohort was majority male (73%) with a mean age of 41 years. Most self-identified as white (76.5%), whereas approximately 16.5% identified as Black and 7% as other racial/ethnic groups (including Hispanic, Asian and Native American). Black individuals comprised a greater proportion of all females (25%) compared with males (13%).
Overall, the prevalence of hypertension was 17%, hyperlipidemia was 41%, smoking was 10%, and diabetes was 3%. The overall prevalence of any CAC was 21%, with 8% having a score of 1-10 Agatston units (AU), 9% scoring 11-100 AU, and 3%scoring >100 AU. Men had a higher prevalence of non-zero CAC (25%) and higher mean CAC scores (18 + 98) than did females (9% and 5 + 70). White individuals had higher CAC scores than Black individuals; the prevalence of CAC >0 was 26% among white males, 16% among Black males, 10% among white females, and 7% among Black females.
CAC >0 automatically placed women, regardless of race, in the 90th percentile of cardiovascular risk, while white men with CAC >0 reached the 90th percentile at age 34 years, as did Black men at age 37 years.
This study provided the first calculator of age-, sex-, and race-based CAC percentiles for ages 30-45 years, derived from the largest study population of CAC among U.S. young adults to date, to fill an important knowledge gap for clinical practice, the authors concluded. CAC percentiles provide a method to interpret how high a CAC score is in an individual relative to his or her age-sex-race matched peers.
In an accompanying editorial, the University of California-Irvine’s Gregory S. Thomas, MD, MPH, (who is also of the Memorial Care Heart & Vascular Institute, Memorial Care Health System, Fountain Valley, California) and Nathan D. Wong, PhD, wrote that. They said that the calculator produced for this study “represents a new standard to characterize the degree of CAC in young white and Black adults in comparison to others in the U.S. population.”
CARDIA is conducted and supported by the National Heart, Lung, and Blood Institute in collaboration with the University of Alabama at Birmingham, Northwestern University, the University of Minnesota (HHSN268201800006I), and the Kaiser Foundation Research Institute. The Coronary Artery Calcium Consortium was supported by a grant from the National Institutes of Health.
Javaid A, Dardari ZA, Mitchell JD, et al. Distribution of Coronary Artery Calcium by Age, Sex, and Race Among Patients 30-45 Years Old. J Am Coll Cardiol 2022;79:1873–1886.
Thomas GS, Wong ND. Detecting Coronary Calcium in Young Adults: Are We There Yet? J Am Coll Cardiol 2022;79:1887–1889.
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