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    Original Investigation
    July 19, 2019

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

    Author Affiliations
    • 1Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
    • 2Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
    • 3Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida
    • 4Department of Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
    • 5Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
    • 6Department of Radiology, Weill Cornell Medical College, New York, New York
    • 7Department of Cardiac Imaging, The Princeton Longevity Center, Princeton, New Jersey
    • 8Department of Medicine, Mount Sinai, New York, New York
    • 9Department of Imaging, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California
    • 10Department of Medicine, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California
    • 11Los Angeles BioMedical Research Institute, Harbor University of California Los Angeles Medical Center, Torrance
    JAMA Netw Open. 2019;2(7):e197440. doi:10.1001/jamanetworkopen.2019.7440
    Key Points español 中文 (chinese)

    Question  What is the prevalence of coronary artery calcium (CAC) in adults aged 30 to 49 years with clinical indications for CAC scoring, and is CAC associated with long-term, cause-specific mortality in these young adults?

    Findings  In this cohort study of 22 346 individuals from the CAC Consortium with clinical indications for CAC, 34.4% had prevalent CAC. The risk of death from coronary heart disease, cardiovascular disease, or all-cause mortality was significantly higher for those with elevated CAC scores, even after multivariable adjustment.

    Meaning  Coronary artery calcium may potentially be used as a tool to aid decision-making among select young adults at elevated lifetime risk for cardiovascular disease; the relatively high prevalence of CAC in younger adults with cardiovascular risk factors reinforces the need for the adoption of healthy lifestyle behaviors early in life.


    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.