TY - JOUR
T1 - Modeling the Recommended Age for Initiating Coronary Artery Calcium Testing Among At-Risk Young Adults
AU - Dzaye, Omar
AU - Razavi, Alexander C.
AU - Dardari, Zeina A.
AU - Shaw, Leslee J.
AU - Berman, Daniel S.
AU - Budoff, Matthew J.
AU - Miedema, Michael D.
AU - Nasir, Khurram
AU - Rozanski, Alan
AU - Rumberger, John A.
AU - Orringer, Carl E.
AU - Smith, Sidney C.
AU - Blankstein, Ron
AU - Whelton, Seamus P.
AU - Mortensen, Martin Bødtker
AU - Blaha, Michael J.
N1 - Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/10/19
Y1 - 2021/10/19
N2 - Background: There are currently no recommendations guiding when best to perform coronary artery calcium (CAC) scanning among young adults to identify those susceptible for developing premature atherosclerosis. Objectives: The purpose of this study was to determine the ideal age at which a first CAC scan has the highest utility according to atherosclerotic cardiovascular disease (ASCVD) risk factor profile. Methods: We included 22,346 CAC Consortium participants aged 30-50 years who underwent noncontrast computed tomography. Sex-specific equations were derived from multivariable logistic modeling to estimate the expected probability of CAC >0 according to age and the presence of ASCVD risk factors. Results: Participants were on average 43.5 years of age, 25% were women, and 34% had CAC >0, in whom the median CAC score was 20. Compared with individuals without risk factors, those with diabetes developed CAC 6.4 years earlier on average, whereas smoking, hypertension, dyslipidemia, and a family history of coronary heart disease were individually associated with developing CAC 3.3-4.3 years earlier. Using a testing yield of 25% for detecting CAC >0, the optimal age for a potential first scan would be at 36.8 years (95% CI: 35.5-38.4 years) in men and 50.3 years (95% CI: 48.7-52.1 years) in women with diabetes, and 42.3 years (95% CI: 41.0-43.9 years) in men and 57.6 years (95% CI: 56.0-59.5 years) in women without risk factors. Conclusions: Our derived risk equations among health-seeking young adults enriched in ASCVD risk factors inform the expected prevalence of CAC >0 and can be used to determine an appropriate age to initiate clinical CAC testing to identify individuals most susceptible for early/premature atherosclerosis.
AB - Background: There are currently no recommendations guiding when best to perform coronary artery calcium (CAC) scanning among young adults to identify those susceptible for developing premature atherosclerosis. Objectives: The purpose of this study was to determine the ideal age at which a first CAC scan has the highest utility according to atherosclerotic cardiovascular disease (ASCVD) risk factor profile. Methods: We included 22,346 CAC Consortium participants aged 30-50 years who underwent noncontrast computed tomography. Sex-specific equations were derived from multivariable logistic modeling to estimate the expected probability of CAC >0 according to age and the presence of ASCVD risk factors. Results: Participants were on average 43.5 years of age, 25% were women, and 34% had CAC >0, in whom the median CAC score was 20. Compared with individuals without risk factors, those with diabetes developed CAC 6.4 years earlier on average, whereas smoking, hypertension, dyslipidemia, and a family history of coronary heart disease were individually associated with developing CAC 3.3-4.3 years earlier. Using a testing yield of 25% for detecting CAC >0, the optimal age for a potential first scan would be at 36.8 years (95% CI: 35.5-38.4 years) in men and 50.3 years (95% CI: 48.7-52.1 years) in women with diabetes, and 42.3 years (95% CI: 41.0-43.9 years) in men and 57.6 years (95% CI: 56.0-59.5 years) in women without risk factors. Conclusions: Our derived risk equations among health-seeking young adults enriched in ASCVD risk factors inform the expected prevalence of CAC >0 and can be used to determine an appropriate age to initiate clinical CAC testing to identify individuals most susceptible for early/premature atherosclerosis.
KW - cardiovascular diseases
KW - coronary artery calcium
KW - multidetector computed tomography
KW - premature atherosclerosis
KW - young adults
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U2 - 10.1016/j.jacc.2021.08.019
DO - 10.1016/j.jacc.2021.08.019
M3 - Article
C2 - 34649694
AN - SCOPUS:85116137304
SN - 0735-1097
VL - 78
SP - 1573
EP - 1583
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 16
ER -