Abstract 13648: Risk Profile and Prognostic Implications of Premature Advanced Atherosclerotic Disease Among Young Adults: The Coronary Artery Calcium Consortium

Abstract

Introduction: Advanced atherosclerotic disease among young adults is an under-recognized and unique disease phenotype that has not been well characterized. Methods: We used data from 23,706 participants aged 30-50 years (mean age 43.9 ± 4.6 years; 74.7% men) from the Coronary Artery Calcium (CAC) Consortium, a cohort of individuals with no prior CVD history referred for CAC scanning. We defined advanced disease as CAC ≥ 90 th percentile for age, sex, and race, and compared risk factor profile of persons with advanced disease to those without CAC and those with CAC < 90 th percentile. Using multivariable-adjusted Cox proportional hazard and competing risks regression, we assessed the association of advanced disease with all-cause, cardiovascular (CV), and CHD mortality. Results: Of the 23,706 participants, 8,289 (35%) had CAC. Among them, 3,549 (43%) had CAC ≥ 90 th percentile. Compared to persons without CAC and those with CAC < 90 th percentile, those with CAC ≥ 90 th had higher prevalence of all the traditional CVD risk factors. Notably, 56% of those with CAC ≥ 90 th percentile had ≥ 2 risk factors, and 68% already had multivessel CAC compared to 34% of those with CAC < 90 th percentile. After a mean follow-up of 12.6 ± 3.6 years, the incidence of all-cause, CV, and CHD mortality was highest in those with advanced disease. Persons with CAC ≥ 90 th percentile had a higher multivariable-adjusted risk of all-cause (HR 2.11 [1.62 - 2.73]), CV (SHR 2.88 [1.74 - 4.78]), and CHD mortality (SHR 4.41 [2.16 - 8.98]), compared to those without CAC. When compared to those with CAC < 90 th percentile, only those with CAC ≥ 90 th percentile had significantly higher risk of all-cause, CV, and CHD mortality ( Figure ). Conclusions: Premature advanced atherosclerosis is a distinct clinical phenotype that strongly predicts all-cause and cause-specific mortality. Among persons with CAC at young age, those with scores ≥ 90th percentile have the highest risk of early death and should be a focus of clinical prevention.