Predictors of coronary artery calcium among 20-30-year-olds: The Coronary Artery Calcium Consortium


      • Coronary Artery Calcium (CAC), a direct marker of coronary atherosclerosis, is an important risk stratification tool.
      • Almost no data are available on the determinants of CAC among very young adults <30 years.
      • These findings reinforce the importance of traditional risk factors in the development of detectable subclinical ASCVD.


      Background and aims

      We sought to understand the risk factor correlates of very early coronary artery calcium (CAC), and the potential investigational value of CAC phenotyping in adults aged 20–30 years.


      We studied all participants aged 20–30 years at baseline (N = 373) in the Coronary Artery Calcium Consortium, a large multi-center cohort study of patients aged 18 years or older without known atherosclerotic cardiovascular disease (ASCVD) at baseline, referred for CAC scoring for clinical risk stratification. We described the prevalence of CAC in men and women, the frequency of risk factors by the presence of CAC (CAC = 0 vs CAC >0), and assessed the association between traditional non-demographic CVD risk factors (hypertension, hyperlipidemia, smoking, family history of CHD, and diabetes) and prevalent CAC, using age- and sex-adjusted logistic regression models.


      The mean age of the study participants was 27.5 ± 2.4 years; 324 (86.9%) had CAC = 0, and 49 (13.1%) had CAC >0. Among the 49 participants with CAC, 38 (77.6%) were men, and median CAC score was low at 4.6. In age- and sex-adjusted models, there was a graded increase in the odds of CAC >0 with increasing traditional cardiovascular disease (CVD) risk factor burden (p = 0.001 for linear trend). Participants with ≥3 traditional risk factors had a statistically significant higher odds of having prevalent CAC (OR 5.57, 95% CI; 1.82–17.03) compared to participants with no risk factors.


      Our study demonstrates the non-negligible prevalence of CAC among very high-risk young US adults, reinforcing the critical importance of traditional risk factors in the earliest development of detectable subclinical ASCVD.

      Graphical abstract


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dzaye O.
        • Dudum R.
        • Mirbolouk M.
        • et al.
        Validation of the coronary artery calcium data and reporting system (CAC-DRS): dual importance of CAC score and CAC distribution from the coronary artery calcium (CAC) consortium.
        J. Cardiovasc. Comput. Tomogr. March 2019;
        • Polonsky T.S.
        • McClelland R.L.
        • Jorgensen N.W.
        • et al.
        Coronary artery calcium score and risk classification for coronary heart disease prediction.
        JAMA, J. Am. Med. Assoc. 2010; 303: 1610-1616
        • Nasir K.
        • Bittencourt M.S.
        • Blaha M.J.
        • et al.
        Implications of coronary artery calcium testing among statin candidates according to American college of cardiology/American heart association cholesterol management guidelines MESA (Multi-Ethnic study of atherosclerosis).
        J. Am. Coll. Cardiol. 2015; 66: 1657-1668
        • McEvoy J.W.
        • Martin S.S.
        • Dardari Z.A.
        • et al.
        Coronary artery calcium to guide a personalized risk-based approach to initiation and intensification of antihypertensive therapy.
        Circulation. 2017; 135: 153-165
        • Miedema M.D.
        • Duprez D.A.
        • Misialek J.R.
        • et al.
        Use of coronary artery calcium testing to guide aspirin utilization for primary prevention: estimates from the multi-ethnic study of atherosclerosis.
        Circ. Cardiovasc. Qual. Outcomes. 2014; 7: 453-460
        • Miedema M.D.
        • Dardari Z.A.
        • Nasir K.
        • et al.
        Association of coronary artery calcium with long-term, cause-specific mortality among young adults.
        JAMA Netw. Open. 2019; 2e197440
        • Zhang Y.
        • Vittinghoff E.
        • Pletcher M.J.
        • et al.
        Associations of blood pressure and cholesterol levels during young adulthood with later cardiovascular events.
        J. Am. Coll. Cardiol. 2019; 74: 330-341
        • Gidding S.S.
        • Robinson J.
        It is now time to focus on risk before age 40.
        J. Am. Coll. Cardiol. 2019; 74: 342-345
        • Blaha M.J.
        • Whelton S.P.
        • Al Rifai M.
        • et al.
        Rationale and design of the coronary artery calcium consortium: a multicenter cohort study.
        J. Cardiovasc. Comput. Tomogr. 2017; 11: 54-61
        • Kang J.
        • Chang Y.
        • Kim S.
        • Sung K.-C.
        • Shin H.
        • Ryu S.
        Increased burden of coronary artery calcium from elevated blood pressure in low-risk young adults.
        Atherosclerosis. 2019; 282: 188-195
        • Carr J.J.
        • Jacobs D.R.
        • Terry J.G.
        • et al.
        Association of coronary artery calcium in adults aged 32 to 46 years with incident coronary heart disease and death.
        JAMA Cardiol. 2017; 2: 391-399
        • McEvoy J.W.
        • Blaha M.J.
        • DeFilippis A.P.
        • et al.
        Coronary artery calcium progression: an important clinical measurement?.
        J. Am. Coll. Cardiol. 2010; 56: 1613-1622
        • McClelland R.L.
        • Jorgensen N.W.
        • Budoff M.
        • et al.
        10-Year coronary heart disease risk prediction using coronary artery calcium and traditional risk factors derivation in the MESA (Multi-Ethnic study of atherosclerosis) with validation in the HNR (Heinz Nixdorf Recall) study and the DHS (Dallas heart study).
        J. Am. Coll. Cardiol. 2015; 66: 1643-1653
        • Budoff M.J.
        • Young R.
        • Lopez V.A.
        • et al.
        Progression of coronary calcium and incident coronary heart disease events: MESA (Multi-Ethnic Study of Atherosclerosis).
        J. Am. Coll. Cardiol. 2013; 61: 1231-1239
        • Joshi P.H.
        • Blaha M.J.
        • Budoff M.J.
        • et al.
        The 10-year prognostic value of zero and minimal CAC.
        JACC Cardiovasc. Imag. 2017; 10: 957-958
        • Blaha M.
        • Budoff M.J.
        • Shaw L.J.
        • et al.
        Absence of coronary artery calcification and all-cause mortality.
        JACC Cardiovasc. Imag. 2009; 2: 692-700