Cumulative Risk Exposure Research Articles

S1828 Cumulative Social Risk Exposure and Risk of Lean MASLD in US Adults: NHANES 2017-2020

S1828 Cumulative Social Risk Exposure and Risk of Lean MASLD in US Adults: NHANES 2017-2020

Cumulative risk and adolescent emotional distress: A longitudinal moderated mediation analysis focusing on perceived stress and social support.

This study provides insights into the roles played by perceived stress and social support in the relationship between cumulative risk exposure (CRE) and adolescent emotional distress. Preregistered longitudinal moderated mediation analyses were used to test hypotheses relating to the association between CRE and later emotional distress; the mediating role of perceived stress in the relationship between CRE and later emotional distress; and, the moderating effects of peer and adult-level family support on the relationship between CRE and later perceived stress, among N = 19,159 adolescents over three annual waves (at ages 11/12, 12/13, 13/14). Analyses revealed that CRE significantly predicted later adolescent emotional distress. This relationship was partially mediated by perceived stress. Both peer and adult-level family support significantly moderated the impact of CRE on later perceived stress (i.e., adolescents reporting higher levels of support perceived significantly lower levels of stress resulting from CRE compared to those reporting lower levels of support). These findings provide critical empirical evidence of the roles played by perceived stress and social support in the relationship between CRE and adolescent emotional distress, with consequent implications for intervention.

Phthalate and DINCH metabolites in the urine of Hungarian schoolchildren: Cumulative risk assessment and exposure determinants

A human biomonitoring study was conducted to assess the exposure of Hungarian children aged 8–11 years to ten phthalate esters (PEs) and DINCH between 2017 and 2018. In addition to collecting urine samples from 262 participants, a questionnaire was completed by the parents or legal guardians to identify potential determinants of exposure.The highest geometric mean concentration was observed for MiBP, followed by MBP, cx- MEHP, OH-MEHP and MEP. Three out of the four DINCH metabolites were detected in more than 90% of the samples. The comparison of the urinary concentrations measured in this study with those observed in the DEMOCOPHES study revealed a significant decreasing trend in all PE metabolites investigated in both studies between 2011/2012 and 2017/2018. Different approaches were used to assess the health risks associated with the exposure to PEs and DINCH. Our results highlighted that the hazard index (HI) values were higher than 1 in 17.6% of the children when the human biomonitoring guidance values were applied. In contrast, less than 3% of the children had HI values exceeding 1 when other sources of reference values were used. By applying a safety factor of 10 for the risk assessment, 17.6–91.6% of the children were characterized by HI values higher than 0.1, indicating the need for risk reduction measures. Overall, DnBP, DiBP and DEHP were identified as the main drivers of the mixture risk. Although PEs and DINCH are ubiquitous contaminants, there are still inconsistencies and gaps in our understanding of the determinants of exposure. The results of the multivariate regression analysis showed significant associations between PE or DINCH metabolite concentrations and certain individual characteristics, use of personal care products, home and school environment and food and beverages consumption 24 h prior to sample collection.

Deep Diving Into the Cardiovascular Health Paradox: A Journey Towards Personalized Prevention.

The Life's Simple 7 score (LS7) promotes cardiovascular health (CVH). Despite this, some with optimal LS7 develop cardiovascular disease (CVD), while others with poor CVH do not, termed the "CVH paradox." This paper explores pathways explaining this paradox. We examined methodological aspects: 1) misclassification bias in self-reported lifestyle factors (smoking, physical activity, diet); 2) cumulative exposure to risk factors over a lifetime, impacting the CVH paradox. Punctual risk factor assessments are suboptimal for predicting outcomes. We proposed personalized prevention using "novel" elements to refine CVH assessment: 1) subclinical vascular disease markers, 2) metabolic biomarkers in blood and urine, 3) emerging risk factors, 4) polygenic risk scores (PRS), 5) epigenetics, and 6) the exposome. Addressing the CVH paradox requires a multifaceted approach, reducing misclassification bias, considering cumulative risk exposure, and incorporating novel personalized prevention elements. A holistic, individualized approach to CVH assessment and CVD prevention can better reduce cardiovascular outcomes and improve population health. Collaboration among researchers, healthcare providers, policymakers, and communities is essential for effective implementation and realization of these strategies.

Episodic foresight, episodic memory, and executive functions in children engaged with Child Protective Services: The role of cumulative risk

Previous studies have determined that exposure to risk and adversities may impair children’s cognitive abilities. In particular, children engaged with Child Protective Services (CPS) seem to be at greater risk for enhanced detrimental effects resulting from the cumulative risk factors to which they are exposed. However, little is known about children’s future thinking when they face adverse circumstances, and it is not clear how the associations among episodic foresight abilities, episodic memory, and executive functions work with children under such circumstances. The current study describes the episodic foresight abilities of CPS-involved school-aged children, its association with other cognitive abilities, and how this association is affected by the exposure to cumulative risk and adversity factors. Episodic foresight, episodic memory, executive functions, and a composite of cumulative risk factors were analyzed in a sample of 95 school-aged children engaged with CPS in Portugal. Results suggest the detrimental effect of cumulative risk on the episodic foresight abilities of CPS-involved children. Episodic memory and cognitive flexibility were significant predictors of episodic foresight abilities, and cumulative risk exposure moderated the relation between episodic memory and episodic foresight. The current study provides a better understanding of the influences of multiple adversities on CPS-involved children’s episodic foresight abilities and related cognitive outcomes.

Association between cumulative metabolic risk exposure and cardiovascular disease: a nationwide cohort of over 3.6 million young adults.

As lifetime accumulation of cardiovascular risk factors is gaining importance, early identification and management of risk factors are being emphasized. The global prevalence of metabolic syndrome (MetS), a constellation of these risk factors, is increasing, particularly among young adults. In this study, we aim to investigate the association between cumulative exposure to metabolic risk and cardiovascular disease (CVD) in young adults. In this nationwide population-based cohort, we analysed 3 688 787 young adults (<40 years) with 2 biennial National Health Screening examinations from 2009 to 2012. Participants were categorized into MetS-free, MetS-developed, MetS-recovered, or MetS-persistent group, based on MetS presence at each examination. The endpoint was new CVD development, including myocardial infarction (MI) and ischaemic stroke. During follow-up (median, 7.7 years), CVD occurred in 19 219 individuals (0.5%). The incidence rates of CVD were 0.58, 1.17, 1.20, and 1.83 (1000 person-years) in the MetS-free, MetS-developed, MetS-recovered, and MetS-persistent groups, respectively. The CVD risk was proportionally associated with cumulative metabolic risk exposure, with a maximum two-fold increase in the MetS-persistent group [adjusted hazard ratio (aHR) 1.94, 95% confidence interval (CI) 1.84-2.04], followed by the MetS-recovered and the MetS-developed groups with similar risks. Among the MetS components, persistent exposure to elevated blood pressure (BP) had the greatest association with CVD risk (aHR 1.69, 95% CI 1.63-1.76). This tendency was consistent in the separate analyses of the risk of MI and ischaemic stroke. The risk of CVD increased in an exposure-dependent manner among young adults. Efforts to optimize the cardiometabolic profile, particularly BP, even after the establishment of MetS, might help promote long-term cardiovascular prognosis.

Cumulative risk exposure is associated with increased risk for PTSD but not depression or anxiety. Results from a UK clinical sample of children and adolescents

Childhood adversity can include traumatic experiences and exposure to other risk factors; consistently predicting poorer psychosocial outcomes in adulthood. Relatively little research has investigated the impact of cumulative risk exposure in childhood. Using data collected in a specialist clinical setting, we investigated the associations between risk exposure, psychopathology and psychosocial functioning. Participants were children attending the Attachment and Trauma service at Great Ormond Street Hospital in London ( N = 132, M = 10.25, SD = 3.35). Data was collected via routine clinical practice during multi-disciplinary assessments. Data was collected on developmental and trauma history, psychopathology, and functioning (CGAS), using standardised measures, clinical interviews, and observations. All children had experienced at least one risk factor, with 78% reporting multiple exposures, including witnessing interpersonal violence (52%), neglect (48%), and physical abuse (42%). Other risk exposures included exposure to alcohol (17%) and substances (24%) in-utero, as well as social risk factors such as multiple foster placements in some cases. In this sample, 65% of children met criteria for at least one psychiatric diagnosis (Anxiety = 31%, PTSD = 28%, Depression = 8%). High levels of functional impairment were found, with 52% of children falling into the highest categories of ‘obvious’ or ‘severe’ problems. Multiple risk exposure significantly predicted PTSD (OR 9.64 (1.1, 83.7)), but did not predict anxiety, depression, or functional impairment. This study highlights the rates of cumulative risk exposure in this clinical sample. The findings demonstrate the importance of detailed and accurate clinical assessments in ascertaining trauma histories in children with known histories of adversity and maltreatment. There are implications for assessment and treatment, such as the importance of clear guidelines on treating PTSD in children with complex trauma histories.

Ecological assessment of Iran’s terrestrial biomes for wildlife conservation

Man-made activities pose the greatest threats to wildlife in Iran's terrestrial biomes, causing significant habitat damage and fragmentation in recent years. To fully understand these threats, the present study was conducted to identify and map the Iran’s terrestrial biomes using the IDRISI TerrSet 18.31 Software, the Terrestrial Biomes Ecosystem Service Modeler on the InVEST toolkit (TBESMI), and comprehensive data sources including maps of roads, protected areas, terrestrial biomes, and country-wide land cover maps of 2017. The results showed that the largest terrestrial biome in Iran is deserts and xeric shrublands (DXS), while flooded grasslands and savannas (FGS) is the smallest biome. Roads, along with urban and agricultural developments are among the biggest threats and most destructive stressors in Iran’s terrestrial biomes. The results also revealed that there was a growth in destruction of habitats located in the temperate broadleaf and mixed forest (TBMF), temperate coniferous forest (TCF), and FGS, alongside a decrease in the DXS biome. Furthermore, we detected an increase in habitat landscape quality in the DXS, FGS and montane grasslands and shrub lands (MGS), and a decrease in the temperate grasslands, savannas and shrublands (TGSS) and TBMF biomes. Finally, the cumulative risk of habitat degradation increased in the FGS, TCF, TGSS, and TBMF biomes, whereas it decreased in the DXS biome. The FGS biome with the highest consequence cumulative score, and the MGS biome with the highest cumulative risk exposure score were found to be at the highest risk from man-made activities. Stressors associated with agriculture and urbanization had the highest cumulative exposure scores in the MGS, while roads had the highest exposure scores in the TBMF and DXS biomes. Our study underscores the critical importance of conserving Iran's terrestrial biomes and wildlife, especially in high-risk biomes like FGS and MGS, given the substantial threats posed by human activities.

Variation in global network properties across risk factors for adolescent internalizing symptoms: evidence of cumulative effects on structure and connectivity.

Identifying adolescents at risk of internalizing problems is a key priority. However, studies have tended to consider such problems in simple ways using diagnoses, or item summaries. Network theory and methods instead allow for more complex interaction between symptoms. Two key hypotheses predict differences in global network properties for those at risk: altered structure and increased connectivity. The current study evaluated these hypotheses for nine risk factors (e.g. income deprivation and low parent/carer support) individually and cumulatively in a large sample of 12-15 year-olds (N = 34 564). Recursive partitioning and bootstrapped networks were used to evaluate structural and connectivity differences. The pattern of network interactions was shown to be significantly different via recursive partitioning for all comparisons across risk-present/absent groups and levels of cumulative risk, except for income deprivation. However, the magnitude of differences appeared small. Most individual risk factors also showed relatively small effects for connectivity. Exceptions were noted for gender and sexual minority risk groups, as well as low parent/carer support, where larger effects were evident. A strong linear trend was observed between increasing cumulative risk exposure and connectivity. A robust approach to considering the effect of risk exposure on global network properties was demonstrated. Results are consistent with the ideas that pathological states are associated with higher connectivity, and that the number of risks, regardless of their nature, is important. Gender/sexual minority status and low parent/carer support had the biggest individual impacts on connectivity, suggesting these are particularly important for identification and prevention.

Effect of gender on the association between cumulative cardiovascular risk factors and depression: results from the US National Health and Nutrition Examination Survey

BackgroundThe comorbidity of cardiovascular disease (CVD) and depression has been well established, as depression usually presents simultaneously with CVD risk factors. However, the potential association between cumulative exposure to CVD...

Relationship between Total Flight Hours and Individual Factors with Low Back Pain in Indonesian Military Helicopter Pilots

Introduction: Helicopter pilots are potentially at risk of Low Back Pain (LBP) and are twice as likely as fighter pilots to experience it. Helicopter pilots’ LBP is caused by a combination of risk factors: engine and rotor vibration, ergonomic risks due to cockpit design, static seating position due to operations, and individual factors. These factors are incorporated into cumulative aviation risk exposure, which can be measured by total flight hours. The prevalence of LBP in Caucasians is high, at 50.5%-92%. However, there has not been any research on Indonesian military helicopter pilots who have a different posture from Caucasians.Objective: To determine the prevalence of LBP, to analyze the relationship between total flight hours and individual factors (age, height, BMI, exercise habits, and smoking habits) with LBP in Indonesian military helicopter pilots.Methods: The study was conducted at the Indonesian Army and Indonesian Air Force with total sampling method as many as 124 people. An explanation was carried out followed by filling in the consent to become a research subject, filling in personal data, anamnesis, Numeric Rating Scale (NRS), physical examination, neurological examination, and total flight hour data.Results: There were 124 subjects, consisting of 37.9% pilots and 62.1% copilots, 87.9% of pilots operate large helicopters, have average total flight hours of 450 hours, age of 30 years, the height of 172.66 cm, low intensity exercise habits of 61.3%, and smokers as much as 45.2%. A total of 57 people (46%) experienced LBP. Statistical results showed that total flight hours had an association with LBP (p = 0.035) where each 1 unit increase in total flight hours had a 1.02 times greater chance of LBP.Conclusion: The prevalence of LBP is 46% and there is an association between total flying hours and LBP in Indonesian military helicopter pilots.

Cumulative Ecological Risk and Academic Burnout in Chinese College Students: A Moderated Mediation Model.

This study explored the relationship between cumulative ecological risk exposure and academic burnout among Chinese college students and the mediating and moderating effects of neuroticism and gender, respectively. A total of 580 college students were selected as participants. They completed a battery of questionnaires that measured cumulative ecological risk, neuroticism, and academic burnout. The results showed that: (1) cumulative ecological risk was positively related to neuroticism and academic burnout; (2) cumulative ecological risk positively predicted academic burnout; (3) neuroticism partly mediated the relationship between cumulative ecological risk and academic burnout; and (4) gender moderated the effect of cumulative ecological risk and academic burnout. A high level of cumulative ecological risk had a greater impact on neuroticism among women, compared to men. These findings advance our current knowledge of the specific effects of cumulative ecological risk on academic burnout and the underlying internal mechanisms of this relationship. Furthermore, this study provides a constructive perspective on preventing and reducing academic burnout among college students.

Home quarantines and cumulative risk exposure among young children: Isolation and maladaptation.

Self-isolation and quarantine are common and effective measures to contain the spread of COVID-19. However, it may have detrimental implications on young children's adaptation and mental health. The present study explores the prevalence of home quarantines among young children in Israel and their associations with children's maladaptive behaviors. The analysis is based on self-reported data obtained by 374 parents of young children in November 2021. Participants completed questionnaires, assessing the prevalence of home quarantines among children (aged 3-11 years old), and maladaptive behaviors, including rage outbursts, physical violence against family or friends, and panic attacks. Multivariate regression models were used to determine the relationships between the number of child quarantines and their maladaptive behaviors. Our results suggest that 51% of parents reported having their child quarantined more than once, which did not differ across socioeconomic characteristics. Furthermore, 66% of parents reported that during the pandemic, their child exhibited maladaptive behaviors at least once. Children who were quarantined more than once were more likely to exhibit rage outbursts, physical violence, and/or panic attacks. The associations between children's quarantine and physical violence were slightly stronger among families living in high-density households. Repeated experiences of home quarantine may operate as exposure to accumulative risk and have a lasting effect on young children's development. Practice and policy recommendations for interventions for young children and their families who experience home quarantines are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Phenotypic divergence in sleep and circadian cycles linked by affective state and environmental risk related to psychosis.

Environmental cues influence circadian rhythm timing and neurochemicals involved in the regulation of affective behavior. How this interplay makes them a probable nonspecific risk factor for psychosis is unclear. We aimed to identify the relationship between environmental risk for psychosis and circadian timing phenotypes sampled from the general population. Using an online survey, we devised a cumulative risk exposure score for each of the 1898 survey respondents based on 23 empirically verified transdiagnostic risks for psychosis, three dimensions of affect severity, psychotic-like experiences, and help-seeking behavior. Quantitative phenotyping of sleep and circadian rhythms was undertaken using at-home polysomnography, melatonin and cortisol profiles, and 3-week rest-activity behavior in individuals with a high-risk exposure load (top 15% of survey respondents, n = 22) and low-risk exposure load (bottom 15% of respondents, n = 22). Psychiatric symptoms were present in 100% of the high-load participants and 14% of the low-load participants. Compared to those with a low-load, high-load participants showed a later melatonin phase which was reflected by a greater degree of dispersion in circadian timing. Phase relationships between later circadian melatonin phase and later actigraphic sleep onsets were maintained and these were strongly correlated with self-reported sleep mid-points. No differences were identified from polysomnography during sleep between groups. Distinguishing circadian timing from other sleep phenotypes will allow adaptation for dosage of time-directed intervention, useful in stabilizing circadian timekeeping physiology and potentially reducing the multisystemic disruption in mental health disorders.

Cumulative risk exposure and child cellular aging in a Dutch low-risk community sample.

One of the proposed mechanisms linking childhood stressor exposure to negative mental and physical health outcomes in later life is cellular aging. In this prospective, longitudinal, and pre-registered study, we examined the association between a cumulative pattern of childhood risk exposure from age 6 to age 10 (i.e., poor maternal mental health, parental relationship problems, family/friend death, bullying victimization, poor quality friendships) and change in two biomarkers of cellular aging (i.e., telomere length, epigenetic age) from age 6 to age 10 in a Dutch low-risk community sample (n=193). We further examined the moderating effect of cortisol reactivity at age 6. Ordinary Least Squares regression analyses revealed no significant main effects of childhood risk exposure on change in cellular aging, nor a moderation effect of child cortisol reactivity. Secondary findings showed a positive correlation between telomere length and cortisol reactivity at age 6, warranting further investigation. More research in similar communities is needed before drawing strong conclusions based on the null results.

Bridging the environment and neurodevelopment for children’s health: Associations between real-time air pollutant exposures and cognitive outcomes

Research suggests that children's exposure to pollutants may impact their neurocognitive development. While researchers have found associations between air pollutants and cognitive development, these associations remain underspecified. Further, these exposures occur in the context of the built environment and may be exacerbated by local social vulnerability; in this context, individuals may experience a suite of socioenvironmental stressors that lead to increased cumulative risk exposure. In this pilot study, we tested whether real-time-measured personal exposure to PM2.5 relates to children's executive function and mathematical skills, outcomes that may predict later mathematical performance, general academic performance and even employment outcomes. We recruited 30 families to participate in two rounds in Winter 2020 and Summer 2021. We collected children's demographic data, as well as data about their living environment. In each round, children carried a small device that collected real-time ambient air pollution data for 3 days; parents logged their children's activities each day. On the last day, children completed cognitive assessments indexing their working memory (n-back), inhibitory control (Go/No-Go), nonsymbolic math skills (dot comparison), and arithmetic skills (equation verification). Overall, 29 participants had pollutant readings from both rounds, and 21 had a full dataset. Nonparametric statistical analysis revealed no significant differences in ambient air pollution and cognitive performance over time, Spearman's rho correlation assessment found that PM2.5 was not significantly correlated with cognitive outcomes in R1 and R2. However, the correlations suggested that an increase in PM2.5 was associated with worse working memory, inhibitory control, nonsymbolic skills, and arithmetic skills, at least in R1. We used each participant's zip code-aggregated Social Vulnerability Index, which range from 0 to 1, with higher numbers indicating more social vulnerability. Wilcoxon Rank-Sum tests indicated that participants living in higher SVI zip codes (≥0.70; n = 15) were not significantly different from those living in lower SVI zip codes (<0.70; n = 14), in terms of their PM2.5 exposures and cognitive performance in each round. We also found that socioeconomic characteristics mattered, such that children whose parent (s) had at least a Master's degree or earned more than $100,000 a year had lower PM2.5 exposures than children in the other end.

Cumulative risk assessment and exposure characteristics of parabens in the general Taiwanese using multiple hazard indices approaches

Cumulative risk assessment and exposure characteristics of parabens in the general Taiwanese using multiple hazard indices approaches

Cumulative risk assessment and exposure characteristics of parabens in the general Taiwanese using multiple hazard indices approaches

Parabens, a group of endocrine disrupting chemicals (EDCs), are well known preservatives in pharmaceuticals and personal care products (PPCPs). However, studies on parabens exposure and their cumulative effects in Asian population are limited. This study aimed to identify the exposure characteristics and estimate the cumulative risk of four parabens in the general Taiwanese. We have collected urine samples including 271 adults (18–97 yrs old) and 95 minors (7–17 yrs old), from Taiwan Environmental Survey for Toxicants 2013, and analyzed for four urinary parabens including methyl (MeP)-, ethyl (EtP)-, propyl (PrP)-, and butylparaben (BuP) by using ultraperformance liquid chromatography–tandem mass spectrometry. The health-based guidance value (HBGV) and the antiandrogenic properties of parabens were used to calculate the hazard index (HI) for cumulative risk. MeP and PrP were most abundant compounds and startlingly higher than those in other countries. Adults had a higher geometric mean level of four parabens than minors (adults: MeP, 381.7; PrP, 108.6; EtP, 39.6 and BuP 6.3 ng/mL; minors: MeP, 65.7; PrP, 7.9, EtP, 2.6 and BuP 2.2 ng/mL). Participants who used a higher number of personal care products had a significantly higher risk with higher concentrations of PrP (above 75th %tile) [adjusted odds ratio (aOR): 1.79, 95 % CI: 1.01–3.15] and BuP [aOR: 1.78, 95 % CI: 1.03–3.07]. The median and 95th %tile HI (the sum of the HQs of each paraben) was as 1.10 and 4.39-fold higher than acceptable cumulative threshold (HI <1) and PrP accounted for 90 % of the HI. Our results indicate omnipresent exposure to parabens among the Taiwanese population, which might cause certain level of concerns. These significant increasing trends of HI with age dependence were observed, which mainly driven by PPCPS used. Routine survey of parabens in PPCPs and continued biomonitoring needs to be urgently addressed.

Changes in Maternal Depression and Children’s Behavior Problems: Investigating the Role of COVID-19-Related Stressors, Hair Cortisol, and Dehydroepiandrosterone

Few studies have used longitudinal approaches to consider the cumulative impact of COVID-19-related stressors (CRSs) on the psychological adjustment of mothers and children. In the current study, we tracked changes in maternal depressive symptoms and children’s behavioral problems from approximately 2 years before the pandemic (T1) to May through August 2020 (T2). Second, we explored maternal hair cortisol and dehydroepiandrosterone as predictors of change in maternal depressive symptoms. Mothers ( N = 120) reported on maternal and child psychological adjustment at both time points. Hair hormone data were collected in the lab at T1. Results suggest increases in children’s internalizing symptoms from T1 to T2 and that higher levels of CRSs were associated with increased maternal depressive symptoms. Maternal and child adjustment were correlated. Maternal hair cortisol, but not dehydroepiandrosterone, was associated with significant increases in depressive symptoms. Findings underscore the importance of considering the family system and cumulative risk exposure on maternal and child mental health.

PDAY risk score predicts cardiovascular events in young adults: the CARDIA study.

Atherosclerotic cardiovascular disease (ASCVD) risk prediction equations apply to older adults. For this study, the Pathobiologic Determinants of Atherosclerosis in Youth (PDAY) risk score, based on post-mortem measurements of atherosclerosis in 15-34-year olds dying accidentally, was used to predict ASCVD events, specifically myocardial infarction and revascularization, in middle age, from risk measured at ≤40 years of age. The Coronary Artery Risk Development in Young Adults Study (CARDIA) collected longitudinal cardiovascular risk data, coronary artery calcium (CAC) scores, and ASCVD data beginning at age 18 and 30 years with 30-year follow-up. Predictive accuracy for ASCVD of the PDAY risk score, calculated at baseline (mean age 24) and at all six CARDIA examinations up until year 15, was examined. We also examined whether the presence of CAC improved model discrimination. The cohort for this study comprised 5004 Black and White men and women, at baseline and 3558 with data at year 15. Each standard deviation increase in PDAY score, at each examination, was significantly associated with future ASCVD. Hazard ratios (per standard deviation) increased from 1.74 to 2.04 from year 0 to year 15. C-statistics ranged from 0.771 to 0.794. Coronary artery calcium measurement at age 33-45 years improved risk prediction only if the score was 0. Cumulative risk exposure over the first 15 years of the CARDIA study also had high-predictive value (c-statistic 0.798, 95% confidence interval 0.762-0.835). The PDAY risk score may be used in young adults, prior to age 40 years to predict ASCVD events.