Young adults with a coronary artery calcium (CAC) score >90% face significantly higher long-term risks of all-cause, cardiovascular disease and coronary heart disease (CHD) mortality, according to a CAC Consortium cohort study published Oct. 23 in JAMA Cardiology.

Using the CAC Consortium dataset, Sungwoo Choi, MD, MPH, Michael J. Blaha, MD, MPH, and colleagues, used multivariable regression models for a time-to-event analysis to examine the association between CAC and all-cause, cardiovascular disease and CHD mortality. The models were adjusted for age, sex and traditional risk factors for ASCVD. They derived the cumulative incidence of the outcomes in five-year increments up to 30 years.

Four institutions across the U.S. provided data to retrospectively assemble the CAC Consortium. Adults aged 30 to 45 years with clinically indicated CAC scans were included in the analysis, which took place from October 2025 to September 2026. Participants had a mean age of 41 years, and 77% were men.

Among almost 13,000 participants, over a median follow-up of 22.6 years, 72% had a CAC score of 0, 13% had a CAC score between 75% and 90% and 13% had a CAC score >90%. In total, there were 624 deaths; 149 were related to cardiovascular disease and 81 to CHD.

After multivariable adjustment, CAC scores >90% were associated with higher mortality compared with a CAC score of 0. Hazard ratios were 1.87 for all-cause mortality, 2.60 for cardiovascular disease mortality and 3.71 for CHD mortality. Over 30 years, participants with a CAC score >90%, compared with a CAC score of 0, had significantly higher modeled risk of all-cause (13% vs. 8%), cardiovascular disease (5% vs. 2%) and CHD (3% vs 1%) mortality.

“Our data may inform future guidelines to acknowledge the unique risk associated with this group, facilitating early preventive measures that mitigate the risk burden that CAC greater than 90% confers throughout the life course,” write Choi and colleagues.