Distribution of Coronary Artery Calcium by Age, Sex, and Race Among Patients 30-45 Years Old

Aamir Javaid, Zeina A. Dardari, Joshua D. Mitchell, Seamus P. Whelton, Omar Dzaye, Joao A.C. Lima, Donald M. Lloyd-Jones, Matthew Budoff, Khurram Nasir, Daniel S. Berman, John Rumberger, Michael D. Miedema, Todd C. Villines, Michael J. Blaha

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


BACKGROUND: Coronary artery calcium (CAC) is a measure of atherosclerotic burden and is well-validated for risk stratification in middle- to older-aged adults. Few studies have investigated CAC in younger adults, and there is no calculator for determining age-, sex-, and race-based percentiles among individuals aged <45 years.

OBJECTIVES: The purpose of this study was to determine the probability of CAC >0 and develop age-sex-race percentiles for U.S. adults aged 30-45 years.

METHODS: We harmonized 3 datasets-CARDIA (Coronary Artery Risk Development in Young Adults), the CAC Consortium, and the Walter Reed Cohort-to study CAC in 19,725 asymptomatic Black and White individuals aged 30-45 years without known atherosclerotic cardiovascular disease. After weighting each cohort equally, the probability of CAC >0 and age-sex-race percentiles of CAC distributions were estimated using nonparametric techniques.

RESULTS: The prevalence of CAC >0 was 26% among White males, 16% among Black males, 10% among White females, and 7% among Black females. CAC >0 automatically placed all females at >90th percentile. CAC >0 placed White males at the 90th percentile at age 34 years compared with Black males at age 37 years. An interactive webpage allows one to enter an age, sex, race, and CAC score to obtain the corresponding estimated percentile.

CONCLUSIONS: In a large cohort of U.S. adults aged 30-45 years without symptomatic atherosclerotic cardiovascular disease, the probability of CAC >0 varied by age, sex, and race. Estimated percentiles may help interpretation of CAC scores among young adults relative to their age-sex-race matched peers and can henceforth be included in CAC score reporting.

Original languageEnglish (US)
Pages (from-to)1873-1886
Number of pages14
JournalJournal of the American College of Cardiology
Issue number19
StatePublished - May 17 2022


  • cardiovascular diseases
  • cardiovascular risk
  • coronary artery calcium
  • coronary artery disease
  • multidetector computed tomography
  • percentiles
  • premature atherosclerosis
  • primary prevention
  • young adults
  • Cardiovascular Diseases
  • Calcium
  • Risk Assessment
  • Humans
  • Middle Aged
  • Risk Factors
  • Male
  • Coronary Artery Disease/diagnostic imaging
  • Young Adult
  • Vascular Calcification/diagnostic imaging
  • Atherosclerosis
  • Adult
  • Female
  • Coronary Vessels/diagnostic imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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