Modeling the Recommended Age for Initiating Coronary Artery Calcium Testing Among At-Risk Young Adults

Omar Dzaye, Alexander C. Razavi, Zeina A. Dardari, Leslee J. Shaw, Daniel S. Berman, Matthew J. Budoff, Michael D. Miedema, Khurram Nasir, Alan Rozanski, John A. Rumberger, Carl E. Orringer, Sidney C. Smith, Ron Blankstein, Seamus P. Whelton, Martin Bødtker Mortensen, Michael J. Blaha

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1573-1583
Number of pages11
JournalJournal of the American College of Cardiology
Issue number16
StatePublished - Oct 19 2021


  • cardiovascular diseases
  • coronary artery calcium
  • multidetector computed tomography
  • premature atherosclerosis
  • young adults

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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