Archives     Advertise     Editorial Calendar     Subscribe     Contact Us    



CAC Raises Heart Disease Risk for Younger Adults


 
Jeffrey Carr, MD

A major report led by Vanderbilt investigators found 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 was strongly associated with increased risk of developing clinical coronary heart disease over the ensuing decade.

The study, which appeared Feb. 8 in JAMA Cardiology, also revealed that those with the highest coronary artery calcium scores, as measured by computed tomography 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 -- has been very limited, especially in African Americans and women.

"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 dramatically and statistically significantly increased risk of clinical heart disease," said Jeffrey Carr, MD, MSc, 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 continued.

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 might 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 pointed out.

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 to 30 in four cities -- Oakland, Minneapolis, Chicago and Birmingham -- 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 NHLBI and Kaiser Permanente. CT scans were performed on 3,330 subjects for the CAC study, and the mean follow-up period was 12.5 years. CAC of any amount was seen in 30 percent of that group.

Investigators sought to answer two primary questions: 1) Can the simple presence of CAC on a chest CT inform clinical practice? 2) Is a CAC score greater than 100 associated with premature death? The answer to both was yes.

"The presence of any coronary artery calcification, even the lowest score, was associated with between a 2.6 and tenfold increase in clinical events over the next 12.5 years," Carr said. "And when it comes to those with high CAC scores (100 or above), the incidence of death was 22 percent, or approximately 1 in 5. Very few times do you get a biomarker, be it genetic or imaging, that predicts death at a level of 22 percent over 12.5 years."

Carr said whether the amount of CAC is high or low, it's presence is a signal that advanced coronary artery disease is present and enhanced prevention could be warranted. A change in clinical practice that could impact care today is that CAC can easily be identified on routine CT scans of the chest obtained for other indications, Carr said.

"Our study provides strong evidence that an individual under age 50 with any amount of CAC is at markedly elevated risk for heart disease; and for healthcare providers and patients, it should be viewed as a call to action to enhance cardiovascular disease prevention," Carr said.

Whether any kind of general screening for CAC is warranted needs additional research, although the study's authors suggest that a "CT scan everyone" strategy in all individuals age 32 to 46 is not indicated. Instead, they suggested a more targeted approach based on measuring risk factors in early adult life to predict individuals at high risk for developing CAC in whom the CT scan would have the greatest value and should be considered.

WEB:
JAMA Article
Dr. Jeff Carr
CARDIA

 
Share:

Related Articles:


Recent Articles

Tax Reform & Healthcare

Medicare cuts and repeal of the individual mandate are two areas of tax reform directly impacting healthcare.

Read More

Senate HELP Committee Hearing on Gene Editing Technology

On Nov. 14, the Senate health committee held a hearing on the gene editing method CRISPR to learn more about the technology from expert witnesses, which included Dr. Matthew Porteus, associate professor of Pediatrics at Stanford University; Katrine Bosley, CEO and president of Editas Medicine; and Dr. Jeffrey Kahn, director of the Johns Hopkins Berman Institute of Bioethics at Johns Hopkins School of Public Health.

Read More

Nashville Health Care Council Hosts Panel Discussion on Pharma/Provider Collaborations in Health Care

On Nov. 13, the Nashville Health Care Council hosted a panel discussion on collaborations between the pharmaceutical and healthcare provider sectors and how those collaborations can drive change in healthcare.

Read More

Tennessee Health Care Hall of Fame Class of 2017

Six healthcare luminaries were recently inducted into the Tennessee Health Care Hall of Fame.

Read More

NMGMA 10 Minute Takeaway

Nashville Medical News recently had the opportunity to chat with new NMGMA president Joy Testa.

Read More

Tennessee Joins Medical Licensing Compact

A new Tennessee law will make it easier for area physicians to practice across state lines beginning in 2019 as part of the Interstate Medical Licensure Compact.

Read More

A Plan to Address COPD

COPD is the third leading cause of death in America, yet it lags behind many other conditions in terms of research dollars and coordinated federal response ... but that seems to be changing.

Read More

Surgical Innovations

Two new procedures recently made their debut in Middle Tennessee offering new treatment options for coronary bifurcation lesions and lumbar fusion.

Read More

Don't fear the FBAR

If you are a taxpayer with offshore financial accounts, you could be in trouble with the IRS and not even know it.

Read More

HoneyCo Homes: Using Smart Technology to Help Seniors Age in Place

A Nashville startup is using technology to help seniors age in place while providing peace of mind to loved ones and actionable data to caregivers.

Read More

Email Print
 
 

 

 


Tags:
American Heart Association, CAC, Calcified Coronary Plaque, Clinical Coronary Heart Disease, Coronary Artery Calcium, Jeff Carr, Predictive Biomarker, Predictive Modeling, Risk Factor, UAB, University of Alabama at Birmingham, Vanderbilt University Medical Center, VUMC
Powered by Bondware
News Publishing Software

The browser you are using is outdated!

You may not be getting all you can out of your browsing experience
and may be open to security risks!

Consider upgrading to the latest version of your browser or choose on below: