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Calcium in coronary arteries of the young may herald heart disease in middle age

By Jane Lewis
The presence of coronary artery calcium (CAC) by ages 32 to 46 years is associated with an increased risk of premature coronary heart disease (CHD) and death during the next 12.5 years, according to new research published online in the JAMA Cardiology.

Professor Michael Feneley AM, Director of Cardiology at St Vincent’s Hospital, Sydney, described the study as ‘a very important piece of research,’ and said that while it does not justify widespread screening to assess CAC in this young age group, it does suggest that ‘looking for CAC may be reasonable in patients in this age group assessed to be at high risk based on clinical risk factor assessment, providing additional risk stratification.’

The study involved 3043 participants from the US community-based Coronary Artery Risk Development in Young Adults (CARDIA) study. At years 15, 20, and 25 after recruitment, CAC measurements were taken by computed tomographic (CT) scan, at which points cohort mean ages were 40.3, 45.3 and 50.1 years, respectively, and CAC prevalence was 10.2%, 20.1% and 28.4%, respectively.

During 12.5 years of follow up from the year-15 scan, there were 57 incident CHD events and 108 incident cardiovascular disease (CVD) events. The presence of any measurable CAC was found to be associated with a five-fold increase in CHD events and a three-fold increase in CVD events. Higher CAC scores were more strongly associated with incident CHD, and those with a CAC score of 100 or more had an incidence of 22.4 deaths per 100 participants – a 3.7-fold increase in all-cause death.

The authors suggested that the exponential increase in CAC scores seen across 10 years is ‘consistent with active coronary atherogenesis’ and ‘a plausible explanation for the association between even low CAC scores in early adult life and the observed CHD events and mortality during middle age.’ 

The authors of an editorial accompanying study said the observed increase in the prevalence of CAC from the third to fifth decade of life ‘is striking’ and ‘suggests that this age span may represent an important time to implement preventive measures to decrease plaque progression or, ideally, to avoid the development of coronary artery disease altogether.’

According to Professor Feneley, it remains to be shown whether treatment – for example, to lower LDL cholesterol levels – can modify the progression of CAC and the associated clinical risk. ‘In the interim, the finding of any CAC should certainly prompt prudent attention to the amelioration of any clinical risk factors in young adults,’ he advised.
JAMA Cardiol 2017; doi: 10.1001/jamacardio.2016.5493.
JAMA Cardiol 2017; doi: 10.1001/jamacardio.2016.5552. 

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