Young Adult Risk Predicts Future Atherosclerosis

Study Questions:

Do coronary risk scores in young adulthood predict coronary artery calcium (CAC) and abdominal aortic calcium (AAC) 25 years later?

Methods:

Data from the Coronary Artery Risk Development in Young Adults (CARDIA) study were used for the present analysis. A total of 3,008 participants had measures of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) risk score at 5-year intervals starting at ages 18-30 years. CAC/AAC were measured at age 43-55 years. The PDAY scores were developed using risk factors (including age, sex, lipids, blood pressure, body mass index, and glycated hemoglobin), modeling the relationship between risk factors (measured post-mortem) and atherosclerosis in coronary arteries found in young adults (ages 15-34 years) who died from external causes (accidents, suicide, or homicide).

Results:

A total of 3,008 participants were included in this analysis. For men, the median coronary PDAY score increased from 2 at baseline (year 0) to 6 at year 25, and the median abdominal aorta PDAY score increased from 1 to 3 over the same interval. For women, the median coronary PDAY score increased from 0 at baseline to 2 at year 25, and the median abdominal aorta PDAY score increased from 2 to 4 over the same interval. The prevalence of CAC was 28% and ACC was 53%. Every 1-point increase in PDAY score increased the odds of CAC (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.25-1.33 vs. OR, 1.12; 95% CI, 1.11-1.14) compared to baseline scores at 25 years. For AAC, the ORs were similar for baseline and 25 years (OR, 1.29; 95% CI, 1.24-1.34 vs. OR, 1.22; 95% CI, 1.19-1.26). C-statistic for CAC prediction was higher at baseline than year 25 (0.731 vs. 0.705), but similar at baseline, and year 25 for AAC (0.665 vs. 0.670).

Conclusions:

The investigators concluded that atherosclerosis risk and change in risk assessed in young adulthood years prior to subclinical atherosclerosis imaging provide strong prediction of future subclinical atherosclerosis. CAC and AAC reflect chronic risk exposure in addition to risk measured at time of study.

Perspective:

These data affirm that atherosclerosis starts at an early age—not just in the coronary arteries, but also the aorta. Furthermore, these results suggest that information on cumulative risk exposure can be derived from CAC scores.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Clinical Topic Collection: Dyslipidemia, Noninvasive Imaging, Prevention, CHD & Pediatrics and Arrhythmias, CHD & Pediatrics and Imaging, CHD & Pediatrics and Prevention, CHD & Pediatrics and Quality Improvement, Lipid Metabolism

Keywords: Aorta, Abdominal, Atherosclerosis, Blood Pressure, Body Mass Index, Coronary Artery Disease, Diagnostic Imaging, Dyslipidemias, Hemoglobin A, Glycosylated, Lipids, Primary Prevention, Risk Factors, Vascular Calcification, Young Adult


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