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Atherosclerotic CVD Risk and Incidence in Young Adults
Quick Takes
- Young adults with a low 10-year predicted atherosclerotic cardiovascular disease (ASCVD) risk, but a high 30-year risk had higher rates of incident ASCVD.
- Young adults with high 30-year risk have a threefold greater incidence of ASCVD compared to those with low 10-year and low 30-year risk.
- Using the 30-year risk prediction tool to identify young adults as candidates for lipid-lowering therapy and other preventive measures may represent an important opportunity to improve patient care.
Study Questions:
What is the performance of short- and long-term atherosclerotic cardiovascular disease (ASCVD) risk prediction tools among young adults?
Methods:
Data from a US integrated health care system (Kaiser Permanente Southern California) were used to examine ASCVD risk among young adults aged 18-39 years in 2008-2009. The cohort was followed through 2019 for ASCVD incidence. Each individual’s index date was defined as the first day in 2008-2009 that they had ≥6 months of continuous eligibility within the health system. Those with a history of ASCVD occurring before the index date were excluded. Those with missing data on risk factors and those with a statin prescription before the index data were also excluded. Race was categorized as self-reported black or nonblack race. Short-term 10-year risk was predicted using the pooled cohort equations, while long-term 30-year ASCVD risk was predicted using the 30-year ASCVD risk prediction tool.
Results:
A total of 414,260 young adults (mean age 29.8 years, 60.6% women) were included in this analysis, of which 813 individuals experienced an ASCVD event during a median of 4 years (maximum follow-up, 11 years). The median (25th, 75th percentiles) 10-year ASCVD predicted risk was 0.6% (0.3%, 1.3%), and the median 30-year predicted risk was 3.1% (1.5%, 6.2%). Compared with 10-year predicted risk, 30-year predicted risk improved reclassification (net reclassification index, 16%) despite having similar discrimination (Harrell’s C: 0.749 vs. 0.726). Overall, 1.0% and 2.2% of young adults were categorized as having elevated 10-year (≥7.5%), and elevated 30-year (≥20%) predicted risk, respectively, and 1.6% as having low 10-year (<7.5%) but elevated 30-year predicted risk. The ASCVD incidence rate per 1,000 person-years was 2.60 (95% confidence interval [CI], 1.92-3.52) for those with elevated 10-year predicted risk, 1.87 (95% CI, 1.42-2.46) for those with low 10-year but elevated 30-year predicted risk, and 0.32 (95% CI, 0.30-0.35) for those with low 10-year and 30-year predicted risk. The age- and sex-adjusted incidence rate ratio was 3.04 (95% CI, 2.25-4.10), comparing those with low 10-year but an elevated 30-year predicted risk to those with low 10-year and 30-year predicted risk.
Conclusions:
The authors concluded that long-term ASCVD risk prediction tools further discriminate a subgroup of young adults with elevated observed risk despite low estimated short-term risk.
Perspective:
These data suggest that young adults with a higher long-term risk for ASCVD, as calculated from the 30-year risk equation, have a higher incidence of ACSVD events, including those with a lower 10-year risk score. As the authors point out, this may represent an opportunity to identify higher-risk adults early, thus allowing for preventive measures aimed at modifiable risk factors.
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Quality Improvement, Nonstatins, Novel Agents, Statins
Keywords: Atherosclerosis, Cardiovascular Diseases, Dyslipidemias, Heart Disease Risk Factors, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Patient Care, Primary Prevention, Risk Factors, Young Adult
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