Coronary artery calcium and the risk of cardiovascular events and mortality in younger adults: a meta-analysis

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 PubMed and Cochrane CENTRAL databases were electronically searched through May 2022 for studies with a primary and results 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. Lay summary This paper compiles prior studies into a meta-analysis to clarify the ability of coronary artery calcium (CAC) to predict cardiovascular risk and mortality risk in adults < 55 years. • A mildly elevated CAC (1–100) in adults < 55 likely has an increased cardiovascular risk but does not appear to have an increased mortality risk. • A moderately or highly elevated CAC (>100) in adults < 55 has a substantial increase in cardiovascular risk and mortality risk.