February 8, 2017 -- Vanderbilt University Medical Center -- A major report led by Vanderbilt investigators found that the mere presence of even a small amount of calcified coronary plaque, more commonly referred to as coronary artery calcium (CAC), in people under age 50 -- even small amounts -- was strongly associated with increased risk of developing clinical coronary heart disease over the ensuing decade.
The study, appearing today (Feb. 8) in JAMA Cardiology, also revealed that those with the highest coronary artery calcium scores, as measured by computed tomography (CT) scan, had a greater than 20 percent chance of dying of a heart event over that same time period.
CAC has long been associated with coronary heart disease and cardiovascular disease. However, prognostic data on CAC in younger adults -- people in their 30s and 40s -- have been very limited, especially in African Americans and women.
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"We always thought you had to have a certain amount of this plaque before you were at risk of having events. What we showed was that, for younger people, any amount of coronary artery calcium or dramatically and statistically significantly increased risk of clinical heart disease," said Jeffrey Carr, M.D., M.Sc., Cornelius Vanderbilt Chair in Radiology and Radiological Sciences at Vanderbilt and lead author of the study.
"Any measurable CAC in early middle age -- scores of less than 100, and even less than 20 -- has a 10 percent risk of heart attack or acute myocardial infarction, both fatal and non-fatal, over the next decade beyond standard risk factors," Carr said.
The study points to CAC as a very specific imaging biomarker for identifying those people who are at risk earlier in life for heart disease, and who may benefit from proven interventions such as cholesterol and blood pressure management, working toward a healthy BMI, smoking cessation and more.
"The person may not be at risk for a heart attack tomorrow or next month, but they are at very high risk over the next 10 years of their life. For individuals at this elevated risk, we have proven interventions that could reduce their risk," Carr said.
Data for this study comes from the National Heart, Lung and Blood Institute (NHLBI) Coronary Artery Risk Development in Young Adults (CARDIA) Study, a longitudinal, community-based study that recruited 5,115 black and white adults age 18-30 in four cities -- Oakland, Minneapolis, Chicago and Birmingham, Alabama -- beginning in 1985 and followed them for 30 years. Institutions participating included Vanderbilt, the University of Minnesota, Northwestern University Feinberg School of Medicine, the University of Alabama at Birmingham, the Colorado School of Public Health, the American heart Association, the National Heart, Lung and Blood Institute and Kaiser Permanente.
