April 26, 2026Journal of the American College of Cardiology85 citationsOpen Access
View Full PaperDistribution of Coronary Artery Calcium by Age, Sex, and Race Among Patients 30-45 Years Old
Key Result
Coronary artery calcium (CAC) >0 was present in 26% of White males, 16% of Black males, 10% of White females, and 7% of Black females among asymptomatic U.S. adults aged 30-45 years.
Key Points
- This study aims to determine the probability of coronary artery calcium >0 and establish age-sex-race percentiles among U.S. adults aged 30-45 years.
- Harmonized 3 datasets: CARDIA, CAC Consortium, and Walter Reed Cohort.
- Studied 19,725 asymptomatic Black and White individuals aged 30-45 years.
- Estimated probability and percentiles using nonparametric techniques.
- 26% prevalence of CAC >0 among White males; 16% among Black males; 10% among White females; 7% among Black females.
- All females with CAC >0 placed above the 90th percentile.
- White males reach the 90th percentile at age 34, Black males at age 37.
Study Design
Type
Cohort (n=19,725)
Multicenter
Yes
Structured PICO
What is the probability of CAC >0 and the age-sex-race percentiles for U.S. adults aged 30-45 years?
P
Population
19,725 asymptomatic Black and White individuals aged 30-45 years without known atherosclerotic cardiovascular disease from 3 datasets (CARDIA, CAC Consortium, and Walter Reed Cohort)
O
Outcome
Probability of CAC >0 and age-sex-race percentiles of CAC distributionssurrogate
This study establishes age-, sex-, and race-based percentiles for coronary artery calcium scores in young U.S. adults aged 30-45 years, facilitating early risk stratification.
Abstract
BACKGROUND Coronary artery calcium (CAC) is a measure of atherosclerotic burden and is well-validated for risk stratification in middle- to older-aged adults. Few studies have investigated CAC in younger adults, and there is no calculator for determining age-, sex-, and race-based percentiles among individuals aged 0 and develop age-sex-race percentiles for U.S. adults aged 30-45 years. METHODS We harmonized 3 datasets-CARDIA (Coronary Artery Risk Development in Young Adults), the CAC Consortium, and the Walter Reed Cohort-to study CAC in 19,725 asymptomatic Black and White individuals aged 30-45 years without known atherosclerotic cardiovascular disease. After weighting each cohort equally, the probability of CAC >0 and age-sex-race percentiles of CAC distributions were estimated using nonparametric techniques. RESULTS The prevalence of CAC >0 was 26% among White males, 16% among Black males, 10% among White females, and 7% among Black females. CAC >0 automatically placed all females at >90th percentile. CAC >0 placed White males at the 90th percentile at age 34 years compared with Black males at age 37 years. An interactive webpage allows one to enter an age, sex, race, and CAC score to obtain the corresponding estimated percentile. CONCLUSIONS In a large cohort of U.S. adults aged 30-45 years without symptomatic atherosclerotic cardiovascular disease, the probability of CAC >0 varied by age, sex, and race. Estimated percentiles may help interpretation of CAC scores among young adults relative to their age-sex-race matched peers and can henceforth be included in CAC score reporting.
Expert Takes4 quotes
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“Identifying calcium in the arteries at young ages is very commonly, in my experience at least, underestimated by clinicians in terms of its abnormality. I think it's a missed opportunity to communicate that, for example, any calcium in the coronary arteries [of a young patient] places you at a very high percentile.”
Michael J. Blaha, Preventive cardiologist, Johns Hopkins Ciccarone CenterJohns Hopkins Universityauto_pipelineView source