High Coronary Calcium in Young Adults Tied to Higher Long-Term Mortality

Adults aged 30 to 45 years with coronary artery calcium (CAC) above the 90th percentile had higher long-term risks of all-cause, cardiovascular, and coronary heart disease mortality than peers with no CAC, according to a cohort study from the CAC Consortium published in JAMA Cardiology.

According to the authors, CAC scoring is a well-established tool for predicting cardiovascular risk, but its long-term prognostic value in young adults has been unclear.

The study used the CAC Consortium dataset, a retrospectively assembled cohort of referred individuals who underwent clinically indicated CAC scans at 4 US institutions. Among 12,847 participants aged 30 to 45 years (mean age, 40.5 years; 77.2% male), 72.1% had a CAC score of 0 and 13.3% had a score above the 90th percentile. Over a median follow-up of 22.6 years, 624 participants died, including 149 from cardiovascular disease (CVD) and 81 from coronary heart disease (CHD). After adjustment for age, sex, and traditional atherosclerotic CVD risk factors, CAC above the 90th percentile was associated with higher all-cause mortality than a score of 0 (hazard ratio, 1.87; 95% CI, 1.54-2.27), with larger hazard ratios for CVD mortality (2.60) and CHD mortality (3.71).

Using a combined Kaplan-Meier and Weibull modeling approach, the investigators estimated 30-year mortality of 12.9% vs 7.5% for all causes, 4.5% vs 1.5% for CVD, and 3.0% vs 0.6% for CHD in the above-90th-percentile and zero-CAC groups, respectively. These 30-year figures are modeled estimates. The study examined CAC and mortality and did not assess the effect of preventive treatment.

The authors concluded that the results suggest potential implications for guiding the intensification of preventive intervention in young adults with this high-risk phenotype.

Source: Choi S, Dzaye O, Dardari Z, et al. Advanced subclinical atherosclerosis in young individuals and risk of mortality over 30 years: the Coronary Artery Calcium Consortium. JAMA Cardiol. Published online October 23, 2026. doi:10.1001/jamacardio.2026.4819