TY - JOUR
T1 - Risk Factors for Incident Coronary Artery Calcium in Younger (Age 32 to 45 Years) Versus Intermediate (46 to 64 Years) Versus Older (65 to 84 Years) Persons
AU - Razavi, Alexander C.
AU - Allen, Norrina B.
AU - Dzaye, Omar
AU - Michos, Erin D.
AU - Budoff, Matthew J.
AU - Lima, Joao A.C.
AU - Shikany, James M.
AU - Liu, Kiang
AU - Post, Wendy S.
AU - Blumenthal, Roger S.
AU - Blaha, Michael J.
AU - Carr, J. Jeffrey
AU - Whelton, Seamus P.
N1 - Funding Information:
Funding: This research was supported by R01 HL071739 and Multi-Ethnic Study of Atherosclerosis (MESA) was supported by contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute (Bethesda, Maryland), and by grants UL1-TR-000040, UL1 TR 001079, and UL1-RR-025005 from National Center for Research Resources (Bethesda, Maryland). This publication was developed under the Science to Achieve Results research assistance agreements, No. RD831697 (MESA Air) and RD-83830001 (MESA Air Next Stage), awarded by the U.S Environmental Protection Agency (Washington, District of Columbia) (EPA). It has not been formally reviewed by the EPA. The views expressed in this document are solely those of the authors and the EPA does not endorse any products or commercial services mentioned in this publication. The Coronary artery Risk Development in Young Adults Study is conducted and supported by the National Heart, Lung, and Blood Institute (Bethesda, Maryland) in collaboration with the University of Alabama at Birmingham, (Birmingham, Alabama) (HHSN268201800005I and HHSN268201800007I), Northwestern University, (Evanston, Illinois) (HHSN268201800003I), University of Minnesota (Minneapolis, Minnesota) (HHSN268201800006I), and Kaiser Foundation Research Institute (Rockville, Maryland) (HHSN268201800004I). This manuscript has been reviewed by MESA and Coronary artery Risk Development in Young Adults Study for scientific content.
Funding Information:
The authors thank the other investigators, the staff, and the participants of the MESA and CARDIA studies for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org. The authors have no conflicts of interest to declare. Funding: This research was supported by R01 HL071739 and Multi-Ethnic Study of Atherosclerosis (MESA) was supported by contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute (Bethesda, Maryland), and by grants UL1-TR-000040, UL1 TR 001079, and UL1-RR-025005 from National Center for Research Resources (Bethesda, Maryland). This publication was developed under the Science to Achieve Results research assistance agreements, No. RD831697 (MESA Air) and RD-83830001 (MESA Air Next Stage), awarded by the U.S Environmental Protection Agency (Washington, District of Columbia) (EPA). It has not been formally reviewed by the EPA. The views expressed in this document are solely those of the authors and the EPA does not endorse any products or commercial services mentioned in this publication. The Coronary artery Risk Development in Young Adults Study is conducted and supported by the National Heart, Lung, and Blood Institute (Bethesda, Maryland) in collaboration with the University of Alabama at Birmingham, (Birmingham, Alabama) (HHSN268201800005I and HHSN268201800007I), Northwestern University, (Evanston, Illinois) (HHSN268201800003I), University of Minnesota (Minneapolis, Minnesota) (HHSN268201800006I), and Kaiser Foundation Research Institute (Rockville, Maryland) (HHSN268201800004I). This manuscript has been reviewed by MESA and Coronary artery Risk Development in Young Adults Study for scientific content.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - The prognostic value of traditional atherosclerotic cardiovascular disease (ASCVD) risk factors may decrease with age. We sought to determine whether the association between traditional ASCVD risk factors and incident coronary artery calcium (CAC) differs for younger versus older persons. We included 5,108 participants with baseline CAC = 0. Repeat CAC scoring occurred over 3 to 11 years of follow-up. Multivariable Cox proportional hazards regression assessed the association between traditional risk factors and incident CAC in young (32 to 45 years), middle-aged (46 to 64 years), and older adults (65 to 84 years). A total of 61% of the participants were women and 37% were Black. The proportion with incident CAC ranged from 22% among young adults, 34% for middle-aged adults, and 45% for older adults. In young adults, traditional risk factors were significantly associated with incident CAC except for diastolic blood pressure and high-density lipoprotein (HDL) cholesterol, whereas only total cholesterol/HDL cholesterol ≥3.5 (p = 0.04) was significantly associated with incident CAC in older persons. Non-HDL cholesterol (p = 0.02) was more strongly associated with incident CAC in young (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.09 to 1.31) and middle aged (HR 1.14, 95% CI 1.07 to 1.23) compared to older adults (HR 1.11, 95% CI 0.99 to 1.23). When added to demographics, traditional risk factors provided a greater C-statistic improvement for incident CAC prediction in young (0.752, +0.070, p <0.001) versus middle-aged (0.645, +0.054, p <0.001) and older adults (0.597,+0.025, p = 0.08). In conclusion, traditional risk factors more strongly predict incident CAC in young compared to older adults, underlining the importance of primordial prevention through middle age while identifying the challenges of ASCVD risk assessment in older persons.
AB - The prognostic value of traditional atherosclerotic cardiovascular disease (ASCVD) risk factors may decrease with age. We sought to determine whether the association between traditional ASCVD risk factors and incident coronary artery calcium (CAC) differs for younger versus older persons. We included 5,108 participants with baseline CAC = 0. Repeat CAC scoring occurred over 3 to 11 years of follow-up. Multivariable Cox proportional hazards regression assessed the association between traditional risk factors and incident CAC in young (32 to 45 years), middle-aged (46 to 64 years), and older adults (65 to 84 years). A total of 61% of the participants were women and 37% were Black. The proportion with incident CAC ranged from 22% among young adults, 34% for middle-aged adults, and 45% for older adults. In young adults, traditional risk factors were significantly associated with incident CAC except for diastolic blood pressure and high-density lipoprotein (HDL) cholesterol, whereas only total cholesterol/HDL cholesterol ≥3.5 (p = 0.04) was significantly associated with incident CAC in older persons. Non-HDL cholesterol (p = 0.02) was more strongly associated with incident CAC in young (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.09 to 1.31) and middle aged (HR 1.14, 95% CI 1.07 to 1.23) compared to older adults (HR 1.11, 95% CI 0.99 to 1.23). When added to demographics, traditional risk factors provided a greater C-statistic improvement for incident CAC prediction in young (0.752, +0.070, p <0.001) versus middle-aged (0.645, +0.054, p <0.001) and older adults (0.597,+0.025, p = 0.08). In conclusion, traditional risk factors more strongly predict incident CAC in young compared to older adults, underlining the importance of primordial prevention through middle age while identifying the challenges of ASCVD risk assessment in older persons.
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U2 - 10.1016/j.amjcard.2022.08.022
DO - 10.1016/j.amjcard.2022.08.022
M3 - Article
C2 - 36154968
AN - SCOPUS:85138813099
SN - 0002-9149
VL - 184
SP - 14
EP - 21
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -
