Abstract MP056: Subclinical Coronary Artery Disease is Present in 28% of Adults 43-55 Years of Age: Recent Findings of the CARDIA Study

Abstract

Background: Coronary artery disease (CAD) starts in childhood and progresses to advanced lesions in adult life. The coronary artery calcium (CAC) score is a measure of subclinical CAD that indicates advanced coronary atheroma and independently predicts future clinical events. Our objective was to document the prevalence and amount of subclinical CAD among black and white adults in early adult life. Methods: The Coronary Artery Risk Development in Young Adults (CARDIA) study is a U.S. population-based, prospective, observational study of black and white men and women. Initially 5,115 participants age of 18-30 yrs were recruited in 1985-6. CAC was measured using non-contrast cardiac CT and reported as the Agatston score at three exams 15, 20 & 25 years after the baseline visit. Results: CAC prevalence was 10.1%(309/3046), 18.6%(583/3140) and 28.1%(890/3160) when the returning cohort was between 33-45 yrs, 38-50 yrs, and 43-55 yrs, respectively (see figure). Prevalence of CAC at all time points was greater in men than women and highest in white men. In the most recent exam, black men had a lower prevalence of CAC (34.3% vs 47.7%) compared to white men but similar distribution of CAC amount. Quartiles of CAC among men with any CAC were: black men 10, 48, 183 and white men 14, 42, 173 (Q1, Q2(median) and Q3 respectively). Change in CAC score among participants in the two most recent CT exams was observed in 29.8% (774/2600). Of those participants, 89.3%(691/774) had any increase in CAC score and 66.7%(516/774) an increase of 10 units or greater. Prevalence of CAC was highly correlated with age and no period effect was observed. Conclusions: 28% of adults less than 55 years of age have advanced plaque in their coronary arteries indicating significant subclinical disease burden. Prevalence is highest in white men, followed by black men and then women in these age ranges. Black men, given CAC, have a comparable amount of CAC to white men. Subclinical CAD is prevalent in early adulthood and once initiated appears to progress in the vast majority of adults.