Increased burden of coronary artery calcium from elevated blood pressure in low-risk young adults

Abstract

Background and aims: The relationship between blood pressure (BP) levels given in the new hypertension guidelines by the American College of Cardiology and the American Heart Association (ACC/AHA) and subclinical coronary atherosclerosis in low-risk young adults is unknown. We evaluated the association between the new BP categories and coronary artery calcium (CAC) in low-risk, young and middle-aged adults.

Methods: We performed a cross-sectional study of 96,166 Koreans who underwent a health examination including cardiac tomography estimation of CAC scores in 2012-2017. BP categories were defined according to the 2017 ACC/AHA guidelines. We used Poisson regression models with robust variance to calculate prevalence ratios (PRs) with 95% confidence intervals (CIs) for prevalent CAC >0.

Results: Overall, higher BP categories were associated with higher CAC scores in both young (aged 20-39) and middle-aged people (aged 40 years or more). After adjusting for possible confounders, including traditional cardiovascular disease (CVD) risk factors, the multivariable-adjusted PRs (95% CI) for prevalent CAC, comparing elevated BP and stage 1 and 2 hypertension to normal BP, were 1.27 (1.08-1.49), 1.45 (1.28-1.63), and 2.02 (1.67-2.43), respectively, among those aged 20-39 years and 1.25 (1.15-1.36), 1.29 (1.23-1.35), and 1.46 (1.36-1.57), respectively, among those aged ≥40 years. This association was also evident in those with a 10-year CVD risk of <10%.

Conclusions: Higher BP categories were positively associated with prevalent CAC, and that association began in the elevated BP category, even in a young and low-risk population.

Keywords: Atherosclerosis; Blood pressure; Coronary artery calcium; Hypertension; Young adults.