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Increased burden of coronary artery calcium from elevated blood pressure in low-risk young adults

  • Jeonggyu Kang
    Affiliations
    Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Yoosoo Chang
    Correspondence
    Corresponding author. Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250 Taepyung-ro 2ga, Jung-gu, Seoul 04514, Republic of Korea.
    Affiliations
    Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
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  • Seolhye Kim
    Affiliations
    Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Ki-Chul Sung
    Affiliations
    Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Hocheol Shin
    Affiliations
    Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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  • Seungho Ryu
    Correspondence
    Corresponding author. Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250 Taepyung-ro 2ga, Jung-gu, Seoul 04514, Republic of Korea.
    Affiliations
    Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
    Search for articles by this author

      Highlights

      • Coronary artery calcium (CAC) was measured in 96,166 Korean adults.
      • Blood pressure (BP) was categorized based on 2017 ACC/AHA guidelines.
      • The burden of CAC increased in the elevated BP category.
      • This association was observed even in low risk and young adults aged 20–39 years.
      • Surveillance and management of high BP is required even in low-risk young adults.

      Abstract

      Background and aims

      The relationship between blood pressure (BP) levels given in the new hypertension guidelines by the American College of Cardiology and the American Heart Association (ACC/AHA) and subclinical coronary atherosclerosis in low-risk young adults is unknown. We evaluated the association between the new BP categories and coronary artery calcium (CAC) in low-risk, young and middle-aged adults.

      Methods

      We performed a cross-sectional study of 96,166 Koreans who underwent a health examination including cardiac tomography estimation of CAC scores in 2012–2017. BP categories were defined according to the 2017 ACC/AHA guidelines. We used Poisson regression models with robust variance to calculate prevalence ratios (PRs) with 95% confidence intervals (CIs) for prevalent CAC >0.

      Results

      Overall, higher BP categories were associated with higher CAC scores in both young (aged 20–39) and middle-aged people (aged 40 years or more). After adjusting for possible confounders, including traditional cardiovascular disease (CVD) risk factors, the multivariable-adjusted PRs (95% CI) for prevalent CAC, comparing elevated BP and stage 1 and 2 hypertension to normal BP, were 1.27 (1.08–1.49), 1.45 (1.28–1.63), and 2.02 (1.67–2.43), respectively, among those aged 20–39 years and 1.25 (1.15–1.36), 1.29 (1.23–1.35), and 1.46 (1.36–1.57), respectively, among those aged ≥40 years. This association was also evident in those with a 10-year CVD risk of <10%.

      Conclusions

      Higher BP categories were positively associated with prevalent CAC, and that association began in the elevated BP category, even in a young and low-risk population.

      Graphical abstract

      Keywords

      Abbreviations:

      ACC/AHA (American College of Cardiology/American Heart Association), ASCVD (atherosclerotic cardiovascular disease), CAC (coronary artery calcium), FRS (Framingham risk score), hsCRP (high sensitivity C-reactive protein), HTN (hypertension)
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      Linked Article

      • Coronary artery calcium score to guide hypertension therapy!
        AtherosclerosisVol. 282
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          Hypertension is the most prevalent non-communicable disease, estimated to affect 1.13 billion individuals nowadays. It is the leading preventable cause of mortality worldwide and a major risk factor for coronary artery disease, heart failure, stroke and chronic renal diseases in developed and developing countries [1,2]. Worldwide, the aging population, decreased fitness and obesity epidemic have contributed to the increased prevalence of hypertension [3]. Given that, it poses a significant health and economic challenge to both developed and developing countries [2].
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