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.
Why the study?
Few studies have investigated CAC in younger adults, and no calculator exists for determining age-, sex-, and race-based percentiles among individuals aged <45 years.
What is the probability of CAC >0 and the age-sex-race percentiles for U.S. adults aged 30-45 years?
Cohort (n=19,725)
Yes
What is the probability of CAC >0 and the age-sex-race percentiles for U.S. adults aged 30-45 years?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“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.”
“The younger you are, the [CAC] score gets lower and lower for predicting the same risk, because we're talking about lifetime risk here for a 30-year-old. For a 60-year-old, we're talking about 10- and 20-year risk.”
“Although universal screening for CAC in young adults should not be endorsed, we suggest certain 'CAC benefit groups' in which ASCVD risk may be sufficiently high to warrant assessment of CAC assessment from a shared-decision discussion between clinician and patient, including consideration of other risk enhancing factors.”
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.
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 <45 years. OBJECTIVES The purpose of this study was to determine the probability of CAC >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.
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Javaid et al. (2022) conducted a cohort in Asymptomatic without known atherosclerotic cardiovascular disease (n=19,725). Coronary artery calcium (CAC) assessment was evaluated on Probability of CAC >0 and age-sex-race percentiles. 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.
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