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Original Investigation
November 27, 2006

Prediction of Coronary Artery Calcium in Young Adults Using the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Risk Score: The CARDIA Study

Author Affiliations

Author Affiliations: Alfred I. duPont Hospital for Children, Wilmington, Del, and Department of Pediatrics, Jefferson Medical College, Philadelphia, Pa (Dr Gidding); Department of Pathology, The University of Texas Health Science Center at San Antonio (Drs McMahan and McGill), and Southwest Foundation for Biomedical Research, San Antonio (Dr McGill); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill (Ms Colangelo and Dr Liu); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (Dr Schreiner); and Division of Preventive Medicine, University of Alabama at Birmingham (Dr Williams).

Arch Intern Med. 2006;166(21):2341-2347. doi:10.1001/archinte.166.21.2341

Background  Using data from autopsied young people aged 15 to 34 years, the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study developed a risk score based on age, sex, smoking status, high-density lipoprotein and non–high-density lipoprotein cholesterol levels, and the presence of obesity, hyperglycemia, and hypertension to predict advanced coronary artery atherosclerosis.

Methods  The Coronary Artery Risk Development in Young Adults (CARDIA) study assessed coronary artery calcium (CAC) by computed tomography in young adults participating in the 15-year examination. The PDAY risk score was calculated from risk factors measured at the CARDIA examinations at years 0, 5, 10, and 15.

Results  Odds ratios for amount of CAC (6 ordinal categories) for a 1-point increase in risk score computed from the modifiable risk factors ranged from 1.10 to 1.16 (all statistically significant). Odds ratios for presence of any amount of CAC ranged from 1.09 to 1.15 (all statistically significant), with the highest odds ratio for the risk score at year 0. An increase in risk score between years 0 and 15 increased the odds of CAC, and a decrease in risk score decreased the odds of CAC. A positive family history of cardiovascular disease increased the odds of CAC. The c statistics ranged from 0.752 to 0.770, with the highest discrimination based on the year 0 revised PDAY risk score that included family history and increased the points for the sex differential.

Conclusion  The PDAY risk score predicts CAC up to 15 years before its assessment, and risk score change during 15 years affects the risk of CAC.