Study Shows That Measuring Coronary Artery Calcium in Young Adults Provides Early Assessment of Cardiovascular Risk
July 19, 2019—The Minneapolis Heart Institute Foundation (MHIF) in Minneapolis, Minnesota, announced the publication of findings regarding measuring coronary artery calcium (CAC) in younger adults to assess cardiovascular risk and thereby guide the intensity of preventive therapies. The study by Michael D. Miedema, MD, et al is available online from the American Medical Association's JAMA Network Open.
According to MHIF, the data were from 22,346 patients in the CAC Consortium, a multicenter retrospective cohort study of individuals undergoing CAC scores for clinical indications, who were aged 30 to 49 years at the time of CAC scoring. The MHIF noted that approximately one in three (34.4%) individuals in this younger population was found to have calcified coronary artery plaque.
During the 12+ years of follow-up, individuals with significant plaque (CAC score > 100) had coronary heart disease death rates 10-times higher than those with zero CAC. Women were less likely to have plaque than men but had similarly elevated rates of cardiovascular death if they were found to have significant plaque.
Dr. Miedema, who is Director of Cardiovascular Prevention at the MHIF, commented in the announcement, “The utility of CAC scoring in middle-aged individuals is relatively well established and is endorsed by the recent national cholesterol guidelines as a method to better assess risk in patients who are uncertain about treatment decisions, but utility of CAC testing in younger adults is much less clear. I think most physicians shy away from CAC testing in younger adults because they assume that nearly all young people will have zero CAC, but we found that one-third of our sample had evidence of premature atherosclerosis.”
Furthermore, Dr. Miedema clarified the importance of how this sample was identified. He stated, “It is really important to understand that this was a sample of individuals with clinical indications for CAC testing, mainly a strong family history of cardiovascular disease or high cholesterol. This was not a sample of the general population; these people were getting a CAC score for a reason, and that is likely why we found a higher prevalence of CAC than we expected.”
Finally, Dr. Miedema emphasized two points that clinicians and patients should understand:
- “First and foremost, these data really reinforces the importance of adopting a healthy lifestyle early in life. We know that the process of building up plaque starts early in life. You shouldn’t wait until you're 50 to start taking could good care of yourself.”
- There is less certainty about whether or not CAC testing should be used in younger adults. Dr. Miedema noted, “To take this study and say that we should now be doing CAC testing in all our patients in their 30s and 40s would be the wrong conclusion. However, for certain select younger adults who have cardiovascular risk factors and are uncertain if and how aggressively they should be treated, a CAC score may provide useful information.”