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Clinical risk scores do not predict lifetime risk of coronary artery disease (CAD) in young adults. We sought to evaluate differences in risk factors among young adults versus older patients in a large, multicenter registry of coronary CT angiography (CCTA).
Patients undergoing CCTA at 53 Michigan institutions in the ACIC were divided into: ≤50 or >50 years of age; demographics and CCTA findings were compared. Logistic regression was performed to determine predictors of obstructive CAD (>50% stenosis).
From July 2007 to September 2012, 24,936 patients without known CAD were enrolled in ACIC, of whom 12,313 patients had CAD (2,519 ≤50; 9,794 >50 years of age). Of these, 4,128 (33.5%) had obstructive CAD (6.3% of patients ≤50 and 22.7% of those >50 years). Those ≤50 had higher prevalence of obesity, family history, and current smoking while those >50 years had a higher frequency of traditional CAD risk factors (all p<0.0001). Younger adults were lower risk by the Framingham criteria (90% vs.43%, p<0.0001). On multivariate analysis, male gender, 10-year age increments, diabetes, smoking, and hypertension were common predictors of obstructive CAD in both groups. However, family history and peripheral vascular disease were distinctly significant in younger and older patients, respectively (Table).
Nearly 30% of young adults had evidence of CAD despite lower Framingham scores, indicating a need for clinical algorithms that predict lifetime risk.
|Age ≤50 N=7,478||Age >50 N=17,458|
|Variable||Odds Ratio||95% CI||Variable||Odds Ratio||95% CI|
|Age (per 10 year increments)||2.25||1.85–2.73||Age (per 10 year increments)||1.76||1.67–1.85|
|Diabetes Mellitus||1.88||1.42–2.49||Diabetes Mellitus||1.28||1.14–1.43|
|Ever Smoker||1.75||1.44–2.13||Ever Smoker||1.29||1.18–1.40|
|Hyperlipidemia||1.62||1.32–1.99||History of Stroke||1.31||1.04–1.64|
|Family History||1.52||1.25–1.85||Peripheral Vascular Disease||1.70||1.33–2.17|
Oral Contributions West, Room 3010
Saturday, March 09, 2013, 8:15 a.m.-8:30 a.m.
Session Title: Coronary Calcium and Cardiac CTA: Diagnosis Prognosis, New Insights
Abstract Category: 20. Imaging: CT/Multimodality
Presentation Number: 908-4
- 2013 American College of Cardiology Foundation