CT CAC associated with long-term mortality in young adults

A high coronary artery calcium (CAC) score was linked to an increased risk for cardiovascular disease (CVD) and mortality in patients between 30 and 49 years old, researchers of a new study published in JAMA Network Open found.

In the analysis of more than 22,000 participants from the CAC Consortium registry, about 34% had some level of CAC and more than 7% had a CAC score of more than 100, according to Michael Miedema, MD, MPH, of the Minneapolis Heart Institute Foundation, and colleagues.

“Our data suggest that the clinical utility of CAC testing may extend to select younger adults, mainly those at elevated lifetime risk for CVD and uncertainty regarding treatment decisions,” the researchers wrote. “Even for individuals in their 30s, despite their young age, approximately 1 in 5 had CAC.”

CAC is directly correlated to atherosclerosis and serves as a useful tool to help clinicians decide on proper preventative therapies for middle-aged adults, but its use in younger people is not as obvious, Miedema et al. noted. This is partially because previous CAC studies for younger adults have been limited by small sample sizes, shorter follow-up times and a lack of cause-specific mortality.

“In response to calls for further research on this subject, we sought to provide data from the CAC Consortium to help determine what role, if any, CAC may play in the identification of young adults at higher risk for CVD who may be candidates for more aggressive therapy for CVD prevention,” the researchers added.

Of the 22,346 patients in the CAC Consortium, 75% were male and the mean age was 43.5 years. All were free of CVD at baseline and underwent initial CAC testing for conditions such as hyperlipidemia (49.6%) or family history of coronary heart disease (49.3%) between 1991 and 2010 with follow-up through June 30, 2014. All patients were examined for cause-specific death at a mean follow up time of 12.7 years. Patient data from the CAC group came from one of four medical centers in Ohio, California and Minnesota.

After follow-up, the researchers reported 298 total deaths; 40 were related to CHD and 84 were CVD-related deaths. Twenty-seven CHD-related deaths were recorded at baseline.

The CHD mortality rate was 0.69 per 1,000 person-years in patients with a CAC score over 100—10-times higher than young adults with a score of zero.

“The high prevalence of premature coronary atherosclerosis in this sample of younger adults highlights the need to increase focus on the importance of adopting healthy lifestyle behaviors early in life,” Miedema and colleagues wrote. “In addition, these findings suggest that CAC testing could potentially be considered for further risk stratification in select young adults with elevated cardiovascular risk.”