Affiliation:
1. Minneapolis Heart Institute Foundation/Abbott Northwestern Hospital , Nolan Family Center for Cardiovascular Health, 920 East 28th Street, Suite 100, Minneapolis, MN 55407 , USA
2. Department of Medicine, Texas A&M University School of Medicine , 8447 Riverside Pkwy, Bryan, TX 77807 , USA
3. Department of Cardiology, Lithuania University of Health Sciences , Kaunas, Lithuania
Abstract
Abstract
Aims
American College of Cardiology/American Heart Association 2019 prevention guidelines recommend utilizing coronary artery calcium (CAC) to stratify cardiovascular risk in selected cases. However, data regarding CAC and risk in younger adults are less robust due to the lower prevalence of CAC and lower incidence of events. The objective of this meta-analysis is to determine the ability of CAC to predict the risk of cardiovascular events and mortality in adults <50.
Methods and results
PubMed and Cochrane CENTRAL databases were electronically searched through May 2022 for studies with a primary prevention cohort under age 55 who underwent CAC scoring. Six observational studies with a total of 45 919 individuals with an average age of 43.1 and mean follow-up of 12.1 years were included. The presence of CAC was associated with an increased risk of adverse events [pooled hazard ratio (HR) = 1.80, 95% confidence interval (CI) 1.26–2.56, P = 0.012, I2 = 65.5]. Compared with a CAC of 0, a CAC of 1–100 did carry an increased risk of cardiovascular events (pooled HR = 1.85, 95% CI 1.08–3.16, P = 0.0248, I2 = 50.3), but not mortality (pooled HR = 1.20, 95% CI 0.85–1.69, P = 0.2917), while a CAC > 100 did carry an increased risk of cardiovascular events (pooled HR = 6.57, 95% CI 3.23–13.36, P < 0.0001, I2 = 72.6) and mortality (pooled HR = 2.91, 95% CI 2.23–3.80, P < 0.0001).
Conclusion
In a meta-analysis of younger adults undergoing CAC scoring, a CAC of 1–100 was associated with a higher likelihood of cardiovascular events, while a CAC > 100 was associated with a higher likelihood of cardiovascular events and mortality.
Publisher
Oxford University Press (OUP)
Subject
Cardiology and Cardiovascular Medicine,Epidemiology
Reference40 articles.
1. 2021 ESC guidelines on cardiovascular disease prevention in clinical practice: developed by the task force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies with the special contribution of the European Association of Preventive Cardiology (EAPC);Visseren;Rev Esp Cardiol (Engl Ed),2022
2. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines;Arnett;Circulation,2019
3. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women;Ridker;N Engl J Med,2005
4. Final report on the aspirin component of the ongoing Physicians’ Health Study;Steering Committee of the Physicians’ Health Study Research Group*;N Engl J Med,1989
5. The Women’s Health Initiative Observational Study: baseline characteristics of participants and reliability of baseline measures;Langer;Ann Epidemiol,2003