Young adults with significant amounts of coronary artery calcium (CAC) are at an increased risk of all-cause mortality, as well as deaths from CVD and CHD causes, over their lifetime when compared with those without any calcification, according to a new study.<\/p>\n\n\n\n
Adults aged 30 to 45 years with the highest CAC scores, defined as greater than the 90th percentile for age, sex, and race, had a near-twofold higher risk of all-cause mortality when compared with those with a CAC score of 0, investigators reported today in JAMA Cardiology<\/em>.<\/p>\n\n\n\n This extent of advanced subclinical atherosclerosis in young people appears to identify a “high-risk phenotype” that may benefit from early aggressive treatment, including lipid-lowering therapy, according to the group. <\/p>\n\n\n\n “The guideline already gives a favorable recommendation to treat anyone with calcium at a young age with a statin,” senior researcher Michael Blaha, MD, MPH (Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD), told Cardiology Now News<\/em>. “That’s already in there and we think that’s great. We’re trying to draw attention to this group above the 90th percentile. Not that anyone with calcium isn’t important, but there’s a subgroup of patients that seem to have a particularly aggressive form of the disease.”<\/p>\n\n\n\n In the 2026 American Heart Association\/American College of Cardiology (AHA\/ACC) guideline for the management of dyslipidemia<\/a>, CAC scoring is strongly recommended to guide treatment decisions in patients at intermediate or borderline risk for atherosclerotic cardiovascular disease (ASCVD). For those with CAC scores of 100 AU or greater, it is recommended physicians initiate lipid-lowering treatment (class 1 recommendation). In the intermediate- or high-risk patient, CAC scores can also be useful to determine the intensity of lipid-lowering therapy (class 2a recommendation).<\/p>\n\n\n\n The new study assessed the long-term implications of coronary calcification in young adults, stratifying individuals into percentiles to assess risk based on relative CAC scores. The study population included 12,847 participants (mean age 40.5 years; 22.8% female) who were part of the CAC Consortium, a retrospective cohort of individuals who underwent clinically indicated CAC scans.<\/p>\n\n\n\n The CAC scores ranged from 0 to 3,650, with the vast majority (72.1%) of participants having no coronary calcification. The mean CAC score was 69.3. In all, 2% of participants had a CAC score greater than 0 but below the 75th percentile for age, sex, and race, 12.7% had a CAC score between the 75th and 90th percentile, and 13.3% had a score exceeding the 90th percentile.<\/p>\n\n\n\n The median follow-up was 22.6 years, up to a maximum of 31.9 years. Compared with those with a CAC score of 0, those in the 90th percentile had a roughly twofold higher risk of all-cause mortality (HR 1.87; 95% CI 1.54-2.27). Those above the 90th percentile also had a higher risk of all-cause mortality compared with those with a CAC score between 75th and 90th percentile. The risk of CVD and CHD mortality was also significantly elevated in those above the 90th percentile compared with those with a CAC score of 0 (HR 2.60; 95% CI 1.77-3.82 and 3.71; 95% CI 2.24-6.16, respectively). <\/p>\n\n\n\n In the first 20 years, the incidence of all-cause mortality was 3.0% in those with a CAC score of 0 compared with 6.9% in those with CAC scores above the 90th percentile. The 20-year incidence of CVD mortality was 0.7% in those with a CAC score of 0 and 2.1% in those in the 90th percentile or higher. Over 30 years, those above 90th percentile had significantly higher risk of death compared with those with zero calcification (all-cause mortality 12.9% vs 7.5%; CVD mortality 4.5% vs 1.5%; and CHD mortality 3.0% vs 0.6%). <\/p>\n\n\n\n To Cardiology Now News<\/em>, Blaha said it’s important to contextualize the CAC scores in young patients. For example, the median CAC score was just 56.4 for the young adults in the 90th percentile.<\/p>\n\n\n\n “Clinicians might say, ‘Well, your score is only 60, but I’ve got patients above 1,000 so 60 isn’t all that bad,'” he said. “Taken in the context of their age, race, and sex, we recognize that they’re manifesting very aggressive, early disease. If you were following these patients, they’re the ones who’ll have a score above 1,000 later in life but we’re identifying them earlier.”<\/p>\n\n\n\n He noted that while those above the 90th percentile made up just a small subset of the total population, they accounted for 30.2% of CVD deaths and 35.8% of CHD deaths over 30-year follow-up. Blaha added that patients included in the CAC Consortium were referred for CAC testing based on their clinical presentation, with roughly half having a family history of CHD or dyslipidemia at baseline.<\/p>\n\n\n\n There are limitations to the new analysis, including that it is not a randomized trial and no recommendations around treatment can be made. Still, Blaha believes the CAC score can be helpful in patients selected for screening based on their clinical profile.<\/p>\n\n\n\n “I certainly think there\u2019s an overall movement towards trying to identify risk earlier, whether that be via PREVENT<\/a> [risk equations], which now goes down to age 30, or other tools,” said Blaha. “We know that intervening earlier leads to more benefit.”<\/p>\n\n\n\n Source:<\/p>\n\n\n\n