High Coronary Artery Calcium Scores Linked to Higher 30-Year Mortality in Young Adults: Study
USA: A high coronary artery calcium (CAC) score in young adults is associated with substantially increased long-term risks of cardiovascular disease and coronary heart disease mortality, a new study published in JAMA Cardiology has revealed. Researchers found that individuals aged 30 to 45 years with CAC scores above the 90th percentile had higher estimated 30-year mortality risks than those with no detectable coronary calcium.
The study, led by Sungwoo Choi of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland, and colleagues, examined the long-term implications of premature subclinical atherosclerosis and its potential role in guiding early cardiovascular prevention.
CAC scoring uses imaging to detect calcium deposits in the coronary arteries, which can indicate underlying atherosclerosis. Although it is an established cardiovascular risk assessment tool, its long-term prognostic significance in younger adults remains less well understood.
For the study, researchers analysed data from 12,847 adults aged 30 to 45 years enrolled in the Coronary Artery Calcium Consortium. Participants underwent clinically indicated CAC scans at institutions across the United States and were followed for a median of 22.6 years. The researchers assessed deaths from all causes, cardiovascular disease (CVD), and coronary heart disease (CHD), adjusting for age, sex, and conventional cardiovascular risk factors.
The participants had a mean age of 40.5 years, and 77.2% were men. A total of 9,262 participants (72.1%) had a CAC score of zero, while 1,703 (13.3%) had scores above the 90th percentile. During follow-up, 624 deaths were recorded, including 149 from cardiovascular disease and 81 from coronary heart disease.
The key findings were:
- All-cause mortality: Participants with CAC scores above the 90th percentile had an 87% higher adjusted hazard of death from any cause than those with a score of zero.
- Cardiovascular mortality: The high-CAC group had a 2.60-fold adjusted hazard of cardiovascular disease death.
- Coronary heart disease mortality: The adjusted hazard of CHD death was 3.71 times higher among those with CAC scores above the 90th percentile.
- Estimated 30-year mortality: The modeled risks of all-cause, cardiovascular and coronary heart disease mortality were 12.9%, 4.5% and 3.0%, respectively, in the high-CAC group, compared with 7.5%, 1.5% and 0.6% among participants with no detectable coronary calcium.
The researchers noted that these findings highlight the potential importance of identifying advanced subclinical atherosclerosis early in life. Detecting elevated CAC in younger adults may help clinicians identify individuals who could benefit from more intensive preventive measures, including risk-factor management.
However, the study used a retrospectively assembled cohort of individuals referred for clinically indicated CAC scans, which may limit the generalisability of the findings to all young adults. The 30-year mortality estimates were also modelled rather than observed across 30 years of follow-up for every participant.
The authors concluded that markedly elevated CAC in young adults is associated with higher long-term mortality risks, supporting further consideration of early cardiovascular risk assessment and targeted prevention in this high-risk group.
Reference:
Choi S, Dzaye O, Dardari Z, et al. Advanced Subclinical Atherosclerosis in Young Individuals and Risk of Mortality Over 30 Years: The Coronary Artery Calcium Consortium. JAMA Cardiol. Published online October 23, 2026. doi:10.1001/jamacardio.2026.4819
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