Risk equations may be used to predict the appropriate age to initiate coronary artery calcium (CAC) testing among young adults at risk of developing premature atherosclerosis, according to study findings published in the Journal of the American College of Cardiology.

Researchers sourced data from the CAC Consortium, which enrolled patients from Cedars-Sinai Medical Center, PrevaHealth Wellness Diagnostic Center, Harbor-UCLA Medical Center, and Minneapolis Heart Institute.

Data from 22,346 participants aged 30 to 50 years, who underwent noncontrast computed tomography with no clinical atherosclerotic cardiovascular disease (ASCVD), were used for a multivariate modeling approach to predict age of CAC greater than 0 according to ASCVD risk factors.


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The mean age for participants was 43.5±4.5 years; 24.9% were women; 87.7% were White; 49.6% had dyslipidemia; 49.3% had a family history of coronary heart disease (CHD); 34.4% had CAC greater than 0; and 20.1% had hypertension.

The 10-year risk for ASCVD among participants was less than 5% for 92.7%, 5% to 7.5% for 4.7%, and greater than 7.5% for 2.6%.

In general, median and mean CAC scores were consistently higher for older adults compared with younger adults, with a steeper curve for men compared with women.

The predicted age at CAC greater than 0 was 57.6 years among women and 42.3 years among men without any ASCVD risk factors. On average, individuals with a family history of CHD were predicted to arrive at CAC status 3.7 years, current smokers 3.3 years, patients with dyslipidemia 4.3 years, hypertension 3.7 years, diabetes 6.4 years, dyslipidemia with a family history of CHD 7.9 years, and hypertension with a family history of CHD 7.3 years earlier than individuals with no risk factors.

The study authors reported a high concordance between observed and expected results, indicating a strong prediction of their risk equations.

These data were likely limited by the overall lack of ethnic diversity among study participants, so these results may not be generalizable to a more diverse population.

The study authors concluded that these risk factors may be effective in guiding physicians for deciding appropriate age for CAC screening.

The researchers noted, “These results suggest that risk factor profiles inform the expected prevalence of premature CAC and can be used to determine the recommended age to initiate an appropriate CAC scan in young adults to identify those who are susceptible for developing premature atherosclerosis.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Dzaye O, Razavi AC, Dardari ZA, et al. Modeling the recommended age for initiating coronary artery calcium testing among at-risk young adults. J Am Coll Cardiol. 2021;78(16):1573-1583. doi:10.1161/JAHA.121.021436