Yuka Otaki1, Heidi Gransar1, Victor Y Cheng2, Damini Dey3, Troy Labounty1, Fay Y Lin4, Stephan Achenbach5, Mouaz Al-Mallah6, Matthew J Budoff7, Filippo Cademartiri8, Tracy Q Callister9, Hyuk-Jae Chang10, Kavitha Chinnaiyan11, Benjamin J W Chow12, Augustin Delago13, Martin Hadamitzky14, Joerg Hausleiter14, Philipp Kaufmann15, Erica Maffei8, Gilbert Raff11, Leslee J Shaw16, Todd C Villines17, Allison Dunning18, Ricardo C Cury19, Gudrun Feuchtner20, Yong-Jin Kim21, Jonathon Leipsic22, Daniel S Berman2, James K Min23. 1. Department of Imaging, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 2. Department of Imaging, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. 3. Department of Imaging, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA Department of Biomedical Sciences, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 4. Department of Medicine, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York, NY, USA. 5. Department of Medicine, University of Erlangen, Erlangen, Germany. 6. Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI, USA. 7. Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA. 8. Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Italy Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands. 9. Tennessee Heart and Vascular Institute, Hendersonville, TN, USA. 10. Division of Cardiology, Severance Cardiovascular Hospital, Seoul, Korea. 11. William Beaumont Hospital, Royal Oak, MI, USA. 12. Department of Medicine and Radiology, University of Ottawa, Ontario, Canada. 13. Capitol Cardiology Associates, Albany, NY, USA. 14. Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany. 15. University Hospital, Zurich, Switzerland. 16. Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. 17. Department of Medicine, Walter Reed Medical Center, Washington, DC, USA. 18. Department of Public Health, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY, USA. 19. Baptist Cardiac and Vascular Institute, Miami, FL, USA. 20. Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria. 21. Seoul National University Hospital, Seoul, South Korea. 22. Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada. 23. Department of Medicine, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York, NY, USA Department of Radiology, Weill Cornell Medical College and the NewYork-Presbyterian Hospital, 413 E. 69th Street, New York, NY 10021, USA jkm2001@med.cornell.edu runone123@gmail.com.
Abstract
OBJECTIVE: Prior studies examining coronary atherosclerosis in the young have been limited by retrospective analyses in small cohorts. We examined the relationship between cardiovascular risk factors (RFs) and prevalence and severity of coronary atherosclerosis in a large, prospective, multinational registry of consecutive young individuals undergoing coronary computerized tomographic angiography (CCTA). METHOD AND RESULTS: Of 27 125 patients undergoing CCTA, 1635 young (<45 years) individuals without known coronary artery disease (CAD) or coronary anomalies were identified. Coronary plaque was assessed for any CAD, obstructive CAD (≥50% stenosis), and presence of calcified plaque (CP) and non-calcified plaque (NCP). Among 1635 subjects (70% men, age 38 ± 6 years), any CAD, obstructive CAD, CP, and NCP were observed in 19, 4, 5, and 8%, respectively. Compared with women, men demonstrated higher rates of any CAD (21 vs. 12%, P < 0.001), CP (6 vs. 3%, P = 0.01), and NCP (9 vs. 5%, P = 0.008), although no difference was observed for rates of obstructive CAD (5 vs. 4%, P = 0.46). Any CAD, obstructive CAD, and NCP were higher for young individuals with diabetes, hypertension, dyslipidaemia, current smoking, or family history of CAD; while only diabetes and dyslipidaemia were associated with CP. Increasing cardiovascular RFs was associated with a greater prevalence and extent and severity of CAD, with individuals with 0, 1, 2, ≥3 RFs manifesting a dose-response increase in any CAD (P < 0.001, for trend), obstructive CAD (P < 0.001, for trend), NCP (P < 0.001, for trend), and CP (P < 0.001, for trend). In multivariable analysis adjusting for sex and cardiovascular RFs, male sex was the strongest predictor for any CAD (odds ratio [OR] = 1.95, 95% confidence interval [CI] = 1.43-2.66, P < 0.001), CP (OR = 1.46, 95% CI = 1.08-1.98, P = 0.01), and NCP (OR = 1.33, 95% CI = 1.06-1.67, P = 0.01); family history of CAD was the strongest predictor for obstructive CAD (OR = 2.71, 95% CI = 1.65-4.45, P < 0.001). CONCLUSION: Any and obstructive CAD is present in 1 in 5 and 1 in 20 young individuals, respectively, with family history associated with the greatest risk of obstructive CAD. Published on behalf of the European Society of Cardiology. All rights reserved.
OBJECTIVE: Prior studies examining coronary atherosclerosis in the young have been limited by retrospective analyses in small cohorts. We examined the relationship between cardiovascular risk factors (RFs) and prevalence and severity of coronary atherosclerosis in a large, prospective, multinational registry of consecutive young individuals undergoing coronary computerized tomographic angiography (CCTA). METHOD AND RESULTS: Of 27 125 patients undergoing CCTA, 1635 young (<45 years) individuals without known coronary artery disease (CAD) or coronary anomalies were identified. Coronary plaque was assessed for any CAD, obstructive CAD (≥50% stenosis), and presence of calcified plaque (CP) and non-calcified plaque (NCP). Among 1635 subjects (70% men, age 38 ± 6 years), any CAD, obstructive CAD, CP, and NCP were observed in 19, 4, 5, and 8%, respectively. Compared with women, men demonstrated higher rates of any CAD (21 vs. 12%, P < 0.001), CP (6 vs. 3%, P = 0.01), and NCP (9 vs. 5%, P = 0.008), although no difference was observed for rates of obstructive CAD (5 vs. 4%, P = 0.46). Any CAD, obstructive CAD, and NCP were higher for young individuals with diabetes, hypertension, dyslipidaemia, current smoking, or family history of CAD; while only diabetes and dyslipidaemia were associated with CP. Increasing cardiovascular RFs was associated with a greater prevalence and extent and severity of CAD, with individuals with 0, 1, 2, ≥3 RFs manifesting a dose-response increase in any CAD (P < 0.001, for trend), obstructive CAD (P < 0.001, for trend), NCP (P < 0.001, for trend), and CP (P < 0.001, for trend). In multivariable analysis adjusting for sex and cardiovascular RFs, male sex was the strongest predictor for any CAD (odds ratio [OR] = 1.95, 95% confidence interval [CI] = 1.43-2.66, P < 0.001), CP (OR = 1.46, 95% CI = 1.08-1.98, P = 0.01), and NCP (OR = 1.33, 95% CI = 1.06-1.67, P = 0.01); family history of CAD was the strongest predictor for obstructive CAD (OR = 2.71, 95% CI = 1.65-4.45, P < 0.001). CONCLUSION: Any and obstructive CAD is present in 1 in 5 and 1 in 20 young individuals, respectively, with family history associated with the greatest risk of obstructive CAD. Published on behalf of the European Society of Cardiology. All rights reserved.
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