Coronary Artery Calcium in Midlife Increases Risk for Heart Disease

According to a new study, the presence of coronary artery calcium (CAC) in individuals between 32 and 64 years of age increased the risk for coronary heart disease (CHD), cardiovascular disease (CVD), and death.

In their study, researcher examined data from the Coronary Artery Risk Development in Young Adults study, which recruited 5115 black and white participants between 18 and 30 years of age, and followed them for 30 years. CAC was measured at 15 years in 3043 participants, at 20 years in 3141 participants, and at 25 years in 3189 participants after recruitment using cardiac computed tomography (CT) scans.
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The present study included data from the 3043 participants measured at 15 years, and followed-up with participants for an average of 12.5 years. Of the 3043 participants, 1383 were men, 1660 were women, and the mean age was 40.3 years.

Researcher used clinical risk factors, which were measured 7 years apart in participants between the ages of 18 and 38 years, to calculate the probability of CAC by age 32 to 56 years.

At year 15, 309 individuals had CAC with a geometric mean Agatston score of 21.6. During the 12.5 year follow-up, 57 incidences of CHD events, and 108 incidences of CVD occurred.

Participants with any CAC experienced a 5-fold increase in CHD events after researchers adjusted for demographics, risk factors, and treatments.

CHD risk was 2.6 for participants with a CAC score strata of 1-19, 5.8 for participants with a CAC score of 20-99, and 9.8 for participants with a CAC score of 100 or more.

“A CAC score of 100 or more had an incidence of 22.4 deaths per 100 participants (HR, 3.7; 95% CI, 1.5-10.0); of the 13 deaths in participants with a CAC score of 100 or more, 10 were adjudicated as CHD events,” the researchers wrote.

Universally screening adults between 32 to 46 years of age is not recommended, but instead a tiered approach that ascertains risk factors for CAC in early adulthood prior to a CT scan. The assessment of risk factors to determine if a patient needs to be screened for CAC would potentially reduce the number of people screened to find a person with CAC from 3.5 to 2.2, and cut the number of unnecessary screening by 50%, according to researchers.

“The finding that CAC present by ages 32 to 46 years is associated with increased risk of premature CHD and death emphasizes the need for reduction of risk factors and primordial prevention beginning in early life,” the researchers concluded.

—Melissa Weiss

Reference:

Carr JJ, Jacobs DR, Terry JG, et al. Association of coronary artery calcium in adults aged 32 to 46 years with incident coronary heart disease and death [published online February 8, 2017]. JAMA Cardiology. doi:10.1001/jamacardio.2016.5493.