Tasdighi Erfan, Brumley Charlie, Vajramani Aashna, Blaha Michael J, Agarwala Anandita
Johns Hopkins University, Baltimore, MD, United States.
Center for Cardiovascular Disease Prevention, Cardiovascular Division, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, TX, United States.
Am J Prev Cardiol. 2025 Jan 22;21:100935. doi: 10.1016/j.ajpc.2025.100935. eCollection 2025 Mar.
Coronary artery calcium (CAC) assessment has long been reserved for intermediate-risk individuals in mid- to older-adult populations. However, a growing body of evidence supports expanding CAC measurement to younger adults who exhibit multiple risk factors or other risk-enhancing features. We describe a case of a very young, 20-year-old, South Asian man with a CAC score of 15.7 Agatston Units. Despite his age and lack of overt symptoms, his CAC score placed him at the 99th percentile for his age and sex, underscoring the limitations of relying solely on traditional risk algorithms. Early CAC detection in such patients has potential for significant clinical impact, allowing timely implementation of intensive lifestyle modification and the most aggressive possible pharmacotherapy for cardiovascular risk reduction. Evidence indicates that even minimal CAC in very young individuals can progress exponentially, markedly increasing the risk of future atherosclerotic cardiovascular disease. Nonetheless, current guidelines do not recommend CAC testing in this population, creating a missed opportunity to detect and intervene in high-risk individuals during early adulthood. These observations underscore the need for more precise risk stratification strategies in select high-risk populations. Incorporating CAC measurements into care for young, high-risk individuals-alongside newer tools such as polygenic risk scores and low-radiation coronary CT angiography-could revolutionize preventive cardiology. Further research is needed to refine the cost-effectiveness and implementation strategies for early CAC measurement, develop more inclusive guidelines, and ensure a specialized workforce capable of delivering comprehensive preventive care.
冠状动脉钙化（CAC）评估长期以来一直局限于中老年人群中的中危个体。然而，越来越多的证据支持将CAC检测扩展至具有多种危险因素或其他风险增强特征的年轻成年人。我们描述了一例非常年轻的20岁南亚男性病例，其CAC评分为15.7阿加斯顿单位。尽管他年龄小且没有明显症状，但他的CAC评分在其年龄和性别的人群中处于第99百分位，这凸显了仅依靠传统风险算法的局限性。在此类患者中早期检测CAC有可能产生重大临床影响，能够及时实施强化生活方式改变以及采取最积极的药物治疗以降低心血管风险。有证据表明，即使是非常年轻个体中的微量CAC也可能呈指数级进展，显著增加未来发生动脉粥样硬化性心血管疾病的风险。尽管如此，当前指南并不推荐对此类人群进行CAC检测，从而错失了在成年早期检测并干预高危个体的机会。这些观察结果强调了在特定高危人群中需要更精确的风险分层策略。将CAC检测纳入年轻高危个体的护理中，再结合多基因风险评分和低辐射冠状动脉CT血管造影等新工具，可能会彻底改变预防心脏病学。需要进一步研究以完善早期CAC检测的成本效益和实施策略，制定更具包容性的指南，并确保有一支能够提供全面预防护理的专业队伍。
