Higher coronary artery calcium levels in middle-age indicate higher risk of later heart problems

Higher coronary artery calcium levels in middle-age are associated with structural heart abnormalities linked to future heart failure, particularly among blacks, according to recently published research (Yared et al Circ Cardiovasc Imaging. 2019;12:e009228. DOI: 10.1161/CIRCIMAGING.119.009228)

Unrelated to the levels of dietary calcium, coronary artery calcium (CAC) is the buildup of calcified plaque consisting of fat, calcium and cholesterol.

CAC is a risk marker for heart health problems, and CAC screening was added to the American Heart Association’s 2018 cholesterol management guidelines to further improve early detection of heart health abnormalities.

In the recent study, researchers tracked 2,449 people from young adulthood to middle-age. Non-invasive CT computed tomography imaging tests were used to gauge the participants’ vascular health, with participants’ imaging tests and CAC scores compared at years 15 and 25 of the study period.

By year 25, participants’ average age was about 50. Seventy-two percent of the group had a CAC score of zero compared with 77% a decade earlier.

We looked at early adulthood to middle-age because this is a window in which we can see abnormalities that might not be causing symptoms, but could later increase the risk of heart problems,” said Dr. H T Moreira, Hospital das Clínicas de Ribeirão Preto at the University of São Paulo in Brazil. “Prevention and control of these abnormalities are key, so early identification of risks can be crucial.”

Moreira and his team found that increases in CAC scores were independently related to increasing age, male sex, black race, higher systolic blood pressure, higher total cholesterol, diabetes mellitus and current smoking, as well as the use of medications to lower blood pressure and cholesterol. Additionally, they found that compared with patients who had CAC scores of zero, those who had higher CAC scores at middle-age had a 12% increase in left ventricular mass and a 9% increase in left ventricular volume, independent of other risk factors including demographic information and cardiovascular risks.

Prior studies have shown that presence of CAC and higher CAC scores are associated with atherosclerotic cardiovascular disease in young to middle aged adults. The results of this study are important as they highlight that presence of CAC and higher CAC scores may also be associated with echocardiographic markers of subclinical LV systolic and diastolic dysfunction,” said Dr. S Virani. “Given the burden of morbidity and mortality associated with heart failure, these are important findings. Prior studies from this cohort have also shown that a better risk factors profile in young adulthood is associated with much lower CAC and therefore, these results further highlight the importance of primordial prevention and risk factor modification in early adulthood.”

Doi : 10.1161IRCIMAGING.119.009228