{"doi":"10.1093/eurjpc/zwaf019","title":"Risk profile and prognostic implications of premature advanced coronary atherosclerotic disease among young to early middle-aged adults: the coronary artery calcium consortium","abstract":"AIMS: Premature advanced subclinical coronary atherosclerosis among young adults is an under-recognized and unique disease phenotype that has not been well characterized. METHODS AND RESULTS: We used data from 44 047 participants with no prior CVD history (59.8% male) from the Coronary Artery Calcium (CAC) Consortium. We defined advanced disease as CAC ≥ 90th percentile for age, sex, and race and compared the risk factor profile of persons with advanced disease to those without CAC and those with CAC < 90th percentile. Using multivariable-adjusted Cox proportional hazard and competing risks regression, we assessed the association of premature advanced disease with all-cause, cardiovascular, and coronary heart disease (CHD) mortality. Of 44 047 participants, 18 561 (42.2%) had CAC. Among those with CAC, 6680 (36.0%) had CAC ≥ 90th percentile. Notably, 76.4% of those with CAC ≥ 90th percentile had multivessel CAC compared with 40.6% of those with CAC < 90th percentile. After a mean follow-up of 12.5 ± 3.6 years, the incidence per 1000 person-years of all-cause (2.93 vs. 1.85 vs. 1.11), cardiovascular (1.11 vs. 0.39 vs. 0.21), and CHD mortality (0.65 vs. 0.19 vs. 0.08) was highest in the advanced disease group compared with CAC < 90th percentile and the no CAC group. Persons with CAC ≥ 90th percentile had a higher multivariable-adjusted risk of all-cause [HR: 2.17 (1.83-2.57)], cardiovascular [sub-distribution hazard ratios (SHR): 3.89 (2.78-5.44)], and CHD mortality [SHR: 5.45 (3.38-8.78)], compared with those without CAC. In the subgroup analysis, there was no difference in mortality between men and women with advanced CAC. CONCLUSION: Premature advanced atherosclerosis is a distinct clinical phenotype that strongly predicts all-cause and cause-specific mortality. Among persons with CAC at young age, those with scores ≥90th percentile have the highest risk of early death and should be identified in future guidelines as a focus for aggressive clinical prevention.","journal":"European Journal of Preventive Cardiology","year":2025,"id":530939,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.5604,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1410861,"name":"Mohammadmoein Dehesh","orcid":"0000-0003-1562-9808","position":1,"is_corresponding":false},{"id":284561,"name":"Zeina Dardari","orcid":"0000-0001-6026-3329","position":2,"is_corresponding":false},{"id":456717,"name":"Olufunmilayo H. Obisesan","orcid":"0000-0001-7247-5257","position":3,"is_corresponding":false},{"id":360822,"name":"Albert D. Osei","orcid":"0000-0002-3901-0471","position":4,"is_corresponding":false},{"id":236228,"name":"Omar Dzaye","orcid":"0000-0001-9483-3510","position":5,"is_corresponding":false},{"id":1031006,"name":"Kunal Jha","orcid":"0000-0002-6613-0241","position":6,"is_corresponding":false},{"id":276022,"name":"Alan Rozanski","orcid":"0000-0002-7278-4890","position":7,"is_corresponding":false},{"id":1411258,"name":"Daniel S Berman","orcid":null,"position":8,"is_corresponding":false},{"id":24934,"name":"Matthew J. Budoff","orcid":"0000-0002-9616-1946","position":9,"is_corresponding":false},{"id":1411259,"name":"Michael D Miedema","orcid":null,"position":10,"is_corresponding":false},{"id":74982,"name":"Khurram Nasir","orcid":"0000-0001-5376-2269","position":11,"is_corresponding":false},{"id":276021,"name":"John A. Rumberger","orcid":"0000-0001-5018-2832","position":12,"is_corresponding":false},{"id":235805,"name":"Leslee J. Shaw","orcid":"0000-0003-1268-1491","position":13,"is_corresponding":false},{"id":71977,"name":"Michael J. Blaha","orcid":"0000-0001-5138-9683","position":14,"is_corresponding":false},{"id":653012,"name":"Ellen Boakye","orcid":"0000-0002-7625-9487","position":0,"is_corresponding":true}],"reference_count":39,"raw_metadata":null,"created_at":"2026-07-19T02:51:10.077559Z","pmid":"39821061","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}