Interaction between risk factors, coronary calcium, and CCTA plaque characteristics in patients aged 18–45 years

Author:

Lorenzatti Daniel1,Piña Pamela12,Huang Dou1,Apple Samuel J1,Fernandez-Hazim Carol1,Ippolito Paul1,Abdullah Aftab1,Rodriguez-Guerra Miguel1,Skendelas John P1,Scotti Andrea1,Kuno Toshiki1,Latib Azeem1,Schenone Aldo L1,Nasir Khurram3,Blankstein Ron45,Blaha Michael J6,Berman Daniel S7,Dey Damini7ORCID,Virani Salim S89,Garcia Mario J1,Slipczuk Leandro1ORCID

Affiliation:

1. Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine , 111 E 210th St, Bronx, NY 10467 , USA

2. Department of Cardiology, CEDIMAT, Arturo Logroño, Plaza de la Salud, Dr. Juan Manuel Taveras Rodríguez, C. Pepillo Salcedo esq, Santo Domingo, Dominican Republic

3. Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist , 6565 Fannin St, Houston, TX 77030 , USA

4. Department of Medicine (Cardiovascular Division), Brigham and Women’s Hospital , 75 Francis St, Boston, MA 02115 , USA

5. Department of Radiology, Brigham and Women’s Hospital , 75 Francis St, Boston, MA 02115 , USA

6. Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine , 1800 Orleans St, Baltimore, MD 21287 , USA

7. Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center , 8705 Gracie Allen Drive, Los Angeles, CA 90048 , USA

8. Department of Medicine, Office of the Vice Provost (Research), The Aga Khan University , National Stadium Rd, Aga Khan University Hospital, Karachi, Karachi City, Sindh , Pakistan

9. Division of Cardiology, The Texas Heart Institute/Baylor College of Medicine , 6770 Bertner Avenue, Houston, TX 77030 , USA

Abstract

Abstract Aims The atherosclerotic profile and advanced plaque subtype burden in symptomatic patients ≤45 years old have not been established. This study aimed to assess the prevalence and predictors of coronary artery calcium (CAC), plaque subtypes, and plaque burden by coronary computed tomography angiography (CCTA) in symptomatic young patients. Methods and results We included 907 symptomatic young patients (18–45 years) from Montefiore undergoing CCTA for chest pain evaluation. Prevalence and predictors of CAC, plaque subtypes, and burden were evaluated using semi-automated software. In the overall population (55% female and 44% Hispanic), 89% had CAC = 0. The likelihood of CAC or any plaque by CCTA increased with >3 risk factors {RFs, odds ratio [OR] 7.13 (2.14–23.7) and OR 10.26 (3.36–31.2), respectively}. Any plaque by CCTA was present in 137 (15%); the strongest independent predictors were age ≥35 years [OR 3.62 (2.05–6.41)] and family history of premature coronary artery disease (FHx) [OR 2.76 (1.67–4.58)]. Stenosis ≥50% was rare (1.8%), with 31% of those having CAC = 0. Significant non-calcified plaque (NCP, 37.2%) and low-attenuation plaque (LAP, 4.24%) burdens were seen, even in those with non-obstructive stenosis. Among patients with CAC = 0, 5% had plaque, and the only predictor of exclusively NCP was FHx [OR 2.29 (1.08–4.86)]. Conclusion In symptomatic young patients undergoing CCTA, the prevalence of CAC or any coronary atherosclerosis was not negligible, and the likelihood increased with RF burden. The presence of coronary stenosis ≥50% was rare and most often accompanied by CAC >0, but there was a significant burden of NCP and LAP even within the non-obstructive group.

Funder

Amgen and Philips

Publisher

Oxford University Press (OUP)

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