Predictors of Coronary Artery Calcium and Long‐Term Risks of Death, Myocardial Infarction, and Stroke in Young Adults

Background Coronary artery calcium (CAC) is well‐validated for cardiovascular disease risk stratification in middle to older–aged adults; however, the 2019 American College of Cardiology/American Heart Association guidelines state that more data are needed regarding the performance of CAC in low‐ris...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Aamir Javaid, Joshua D. Mitchell, Todd C. Villines
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	calcium score coronary artery calcium coronary artery disease heart disease risk factors multidetector computed tomography myocardial infarction Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/3105d003c017414890da5db9f217e215
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:3105d003c017414890da5db9f217e215
record_format	dspace
spelling	oai:doaj.org-article:3105d003c017414890da5db9f217e2152021-11-16T10:22:43ZPredictors of Coronary Artery Calcium and Long‐Term Risks of Death, Myocardial Infarction, and Stroke in Young Adults10.1161/JAHA.121.0225132047-9980https://doaj.org/article/3105d003c017414890da5db9f217e2152021-11-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.022513https://doaj.org/toc/2047-9980Background Coronary artery calcium (CAC) is well‐validated for cardiovascular disease risk stratification in middle to older–aged adults; however, the 2019 American College of Cardiology/American Heart Association guidelines state that more data are needed regarding the performance of CAC in low‐risk younger adults. Methods and Results We measured CAC in 13 397 patients aged 30 to 49 years without known cardiovascular disease or malignancy between 1997 and 2009. Outcomes of myocardial infarction (MI), stroke, major adverse cardiovascular events (MACE; MI, stroke, or cardiovascular death), and all‐cause mortality were assessed using Cox proportional hazard models, controlling for baseline risk factors (including atrial fibrillation for stroke and MACE) and the competing risk of death or noncardiac death as appropriate. The cohort (74% men, mean age 44 years, and 76% with ≤1 cardiovascular disease risk factor) had a 20.6% prevalence of any CAC. CAC was independently predicted by age, male sex, White race, and cardiovascular disease risk factors. Over a mean of 11 years of follow‐up, the relative adjusted subhazard ratio of CAC >0 was 2.9 for MI and 1.6 for MACE. CAC >100 was associated with significantly increased hazards of MI (adjusted subhazard ratio, 5.2), MACE (adjusted subhazard ratio, 3.1), stroke (adjusted subhazard ratio, 1.7), and all‐cause mortality (hazard ratio, 2.1). CAC significantly improved the prognostic accuracy of risk factors for MACE, MI, and all‐cause mortality by the likelihood ratio test (P<0.05). Conclusions CAC was prevalent in a large sample of low‐risk young adults. Those with any CAC had significantly higher long‐term hazards of MACE and MI, while severe CAC increased hazards for all outcomes including death. CAC may have utility for clinical decision‐making among select young adults.Aamir JavaidJoshua D. MitchellTodd C. VillinesWileyarticlecalcium scorecoronary artery calciumcoronary artery diseaseheart disease risk factorsmultidetector computed tomographymyocardial infarctionDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 22 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	calcium score coronary artery calcium coronary artery disease heart disease risk factors multidetector computed tomography myocardial infarction Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	calcium score coronary artery calcium coronary artery disease heart disease risk factors multidetector computed tomography myocardial infarction Diseases of the circulatory (Cardiovascular) system RC666-701 Aamir Javaid Joshua D. Mitchell Todd C. Villines Predictors of Coronary Artery Calcium and Long‐Term Risks of Death, Myocardial Infarction, and Stroke in Young Adults
description	Background Coronary artery calcium (CAC) is well‐validated for cardiovascular disease risk stratification in middle to older–aged adults; however, the 2019 American College of Cardiology/American Heart Association guidelines state that more data are needed regarding the performance of CAC in low‐risk younger adults. Methods and Results We measured CAC in 13 397 patients aged 30 to 49 years without known cardiovascular disease or malignancy between 1997 and 2009. Outcomes of myocardial infarction (MI), stroke, major adverse cardiovascular events (MACE; MI, stroke, or cardiovascular death), and all‐cause mortality were assessed using Cox proportional hazard models, controlling for baseline risk factors (including atrial fibrillation for stroke and MACE) and the competing risk of death or noncardiac death as appropriate. The cohort (74% men, mean age 44 years, and 76% with ≤1 cardiovascular disease risk factor) had a 20.6% prevalence of any CAC. CAC was independently predicted by age, male sex, White race, and cardiovascular disease risk factors. Over a mean of 11 years of follow‐up, the relative adjusted subhazard ratio of CAC >0 was 2.9 for MI and 1.6 for MACE. CAC >100 was associated with significantly increased hazards of MI (adjusted subhazard ratio, 5.2), MACE (adjusted subhazard ratio, 3.1), stroke (adjusted subhazard ratio, 1.7), and all‐cause mortality (hazard ratio, 2.1). CAC significantly improved the prognostic accuracy of risk factors for MACE, MI, and all‐cause mortality by the likelihood ratio test (P<0.05). Conclusions CAC was prevalent in a large sample of low‐risk young adults. Those with any CAC had significantly higher long‐term hazards of MACE and MI, while severe CAC increased hazards for all outcomes including death. CAC may have utility for clinical decision‐making among select young adults.
format	article
author	Aamir Javaid Joshua D. Mitchell Todd C. Villines
author_facet	Aamir Javaid Joshua D. Mitchell Todd C. Villines
author_sort	Aamir Javaid
title	Predictors of Coronary Artery Calcium and Long‐Term Risks of Death, Myocardial Infarction, and Stroke in Young Adults
title_short	Predictors of Coronary Artery Calcium and Long‐Term Risks of Death, Myocardial Infarction, and Stroke in Young Adults
title_full	Predictors of Coronary Artery Calcium and Long‐Term Risks of Death, Myocardial Infarction, and Stroke in Young Adults
title_fullStr	Predictors of Coronary Artery Calcium and Long‐Term Risks of Death, Myocardial Infarction, and Stroke in Young Adults
title_full_unstemmed	Predictors of Coronary Artery Calcium and Long‐Term Risks of Death, Myocardial Infarction, and Stroke in Young Adults
title_sort	predictors of coronary artery calcium and long‐term risks of death, myocardial infarction, and stroke in young adults
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/3105d003c017414890da5db9f217e215
work_keys_str_mv	AT aamirjavaid predictorsofcoronaryarterycalciumandlongtermrisksofdeathmyocardialinfarctionandstrokeinyoungadults AT joshuadmitchell predictorsofcoronaryarterycalciumandlongtermrisksofdeathmyocardialinfarctionandstrokeinyoungadults AT toddcvillines predictorsofcoronaryarterycalciumandlongtermrisksofdeathmyocardialinfarctionandstrokeinyoungadults
_version_	1718426534223544320

Predictors of Coronary Artery Calcium and Long‐Term Risks of Death, Myocardial Infarction, and Stroke in Young Adults

Ejemplares similares