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PDAY Risk Score Predicts Cardiovascular Events in Young Adults
Quick Takes
- Risk factors measured using the PDAY framework can be predictive of coronary artery disease in young adults beginning at 18–30 years of age.
- Coronary artery calcium (CAC) measurement obtained at 33–45 years of age added to the prediction only if CAC was zero.
Study Questions:
Can the PDAY (Pathobiologic Determinants of Atherosclerosis in Youth) risk score predict risk for coronary artery disease?
Methods:
Data from CARDIA (Coronary Artery Risk Development in Young Adults Study), a longitudinal study initiated in 1985–1986, were used for the present analysis. This study included Black and White men and women recruited between the ages of 18–30 years from four US locations (Chicago, IL; Birmingham, AL; Oakland, CA; and Minneapolis, MN). Coronary artery calcium (CAC) was measured in year 15 (2000–2001). The PDAY risk score is based on post-mortem measurement of atherosclerosis in 15- to 34-year-olds who died from accidental causes. The score was derived to predict cardiac events, including myocardial infarction and revascularization in middle age, from risks measured at ≤40 years. The PDAY score includes eight risk factors: age, sex, non–high-density lipoprotein (HDL) cholesterol, HDL cholesterol, smoking, blood pressure, obesity, and hyperglycemia. This analysis included 30 years of follow-up. The outcome of atherosclerotic cardiovascular disease (ASCVD) events was defined as hospitalization for myocardial infarction or acute coronary syndrome with increasing symptoms consistent with ischemia but without infarction or coronary heart disease death or coronary revascularization. The presence of CAC was also examined for improved model discrimination.
Results:
There were 5,004 patients at baseline (1985–1986); 3,558 returned for the year 15 study visit (2000–2001) and were included in the present analysis. PDAY score increased with age. The risk factor burden also increased with age. Each standard deviation (SD) increase in PDAY score at each examination was significantly associated with future ASCVD. Hazard ratios (per SD) increased from 1.74–2.04 from year 0–year 15. The model demonstrated good discrimination with C-statistics ranging from 0.771–0.794. CAC measurement at age 33–45 years improved risk prediction only if the score was 0. Cumulative risk exposure over the first 15 years of the CARDIA study also had a high predictive value (c-statistic, 0.798; 95% confidence interval, 0.762–0.835).
Conclusions:
The investigators concluded that the PDAY risk score might be used in young adults before age 40 to predict ASCVD events. Given that most ASCVD events occur prior to the age of 65 and atherosclerotic changes begin at far younger ages, there is a strong need to develop prevention strategies early in life.
Perspective:
Understanding who is at higher risk for ASCVD events when the individual is young allows for an opportunity to strengthen primary prevention efforts among higher-risk individuals. This study suggests that the PDAY risk score may offer a useful tool among young adults. However, it is warranted to examine the accuracy of this risk score in other cohorts, including those in other racial and ethnic groups.
Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Prevention, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Lipid Metabolism, Nonstatins, Interventions and ACS, Interventions and Coronary Artery Disease, Smoking
Keywords: Acute Coronary Syndrome, Atherosclerosis, Blood Pressure, Cholesterol, HDL, Coronary Artery Disease, Ethnic Groups, Hyperglycemia, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Obesity, Plaque, Atherosclerotic, Primary Prevention, Risk Factors, Smoking, Young Adult
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