CT Coronary Artery Calcium- Useful tool to predict future risks of heart attack and stroke in young

Computed Tomography (CT) Coronary artery calcium (CT CAC) may have potential utility as a tool to aid decision-making among select young adults at an elevated lifetime risk of heart attack and stroke, revealed a study published in JAMA Open Networks.

Many studies have shown a link between high calcium scores and heart disease and the potential benefits of CT CAC in determining an individual's risk of cardiac conditions. As a result, the American Heart Association (AHA) and the American College of Cardiology (ACC) have framed their most recent guidelines to support the use of CT CAC testing for adults at risk of developing atherosclerotic heart disease.

Coronary artery calcium (CAC) is a direct marker of atherosclerosis that can strongly scale the risk for people without known CVD, enabling it to serve as a means to assist clinical decision-making considering for middle-aged adults preventive therapies. Prior CAC studies for younger adults have been limited by small sample sizes, a short duration of follow-up, and a lack of cause-specific mortality.

In a 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.

The study was designed to 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.

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.

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.

Key findings

• The sample of 22 346 participants had a high prevalence of hyperlipidemia and family history of CHD but a low prevalence of current smoking and diabetes.


• The prevalence of any CAC was 34.4%, with 7.2% having a CAC score of more than 100.


• During follow-up, there were 40 deaths related to CHD, 84 deaths related to CVD, and 298 total deaths.


• A total of 27 deaths related to CHD 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 compared with those with a CAC score of 0.


• After multivariable adjustment, those with a CAC score of more than 100 had a significantly increased risk of CHD, CVD, and all-cause mortality compared with those with a CAC score of 0.

To conclude the study the authors wrote: "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."