Young adults aged 30 to 45 with the highest CT coronary artery calcium (CAC) scores face nearly double the risk of dying from any cause over 30 years compared to those without detectable calcium, according to a study published in JAMA Cardiology. This finding suggests that early CAC screening and targeted preventive interventions in young adults with high scores could provide substantial lifetime health benefits.
- Young adults with CAC scores above the 90th percentile have a 1.87 times higher hazard ratio for all-cause mortality compared to those with no detectable calcium.
- Over 30 years, all-cause mortality risk was 12.9% in the highest CAC group versus 7.5% in those with CAC = 0.
- Cardiovascular disease (CVD) mortality risk was three-fold higher (4.5% vs 1.5%) and coronary heart disease (CHD) mortality risk was nearly five-fold higher (3.0% vs 0.6%) in high CAC groups.
- The study analyzed 12,847 young adults aged 30-45 years from four U.S. institutions with a median follow-up of 22.6 years.
- Current prevention and cholesterol guidelines do not specifically address high CAC scores in young adults, highlighting a critical gap in clinical guidance.
Young adults with the highest CT coronary artery calcium (CAC) scores face nearly double the 30-year all-cause mortality risk compared to their peers with absent CAC, according to a study published October 23 in JAMA Cardiology.
The finding suggests that early identification of young adults with high CAC scores and targeted preventive intervention in this group may yield substantial lifetime benefit, noted lead author Sungwoo Choi, MD, of Johns Hopkins University in Baltimore, MD, and colleagues.
"With growing recognition of the benefits of early detection and preventive intervention, our study addresses a critical gap in the literature and offers utility in guiding the intensification of preventive management," the group wrote.
CAC scanning is well established for predicting 10-year cardiovascular risk, but its long-term prognostic value in young adults has remained unclear, the authors wrote. Absolute CAC scores in young adults aged 30 to 45 years old are typically low, even when relative percentile scores may be high. This discordance has complicated risk communication and underscored the need for long-term mortality evidence in this population, they added.
To bridge the gap, the researchers drew data from the CAC Consortium, a retrospective cohort of adults aged 30 to 45 years with clinically indicated CAC scans from four U.S. institutions. Scans were performed using noncontrast cardiac-gated CT and quantified using the Agatston method. Participants were followed for a median of 22.6 years for underlying cause of mortality.
Among 12,847 participants, 1,703 (13.3%) had CAC scores above the 90th percentile. This group had nearly double the hazard of all-cause mortality compared with those without detectable calcium (hazard ratio [HR], 1.87), as well as 2.6 times the hazard of cardiovascular disease (CVD) mortality and 3.7 times the hazard of coronary heart disease (CHD) mortality, according to the findings.
Over 30 years, all-cause mortality risk was 12.9% in the highest CAC group versus 7.5% in those with CAC = 0. CVD mortality risk was three-fold higher (4.5% versus 1.5%) and CHD mortality risk nearly five-fold higher (3.0% versus 0.6%), the researchers reported.
"This cohort study was the first, to our knowledge, to describe long-term risk of mortality up to 30 years associated with advanced subclinical atherosclerosis in young adults aged 30 to 45 years, with an emphasis on individuals with CAC above the 90th percentile," the authors wrote.
Despite the risk associated with CAC greater than 90% in the study, current prevention and cholesterol guidelines do not specifically address this phenotype and provide limited guidance on CAC scoring in young adults, the researchers noted.
"Our data may inform future guidelines to acknowledge the unique risk associated with this group," the researchers concluded.
The full study is available here.
