Incidence of Atherosclerotic Cardiovascular Disease in Young Adults at Low Short-Term But High Long-Term Risk

Journal of the American College of Cardiology · 8 authors, 5 centres

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TL;DR

Over a median of 4.0 years, 813 incident ASCVD events occurred.

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Over a median of 4.0 years, 813 incident ASCVD events occurred. The 30-year risk equation had similar discrimination to the 10-year equation (Harrell's C: 0.749 vs 0.726) but improved reclassification (NRI: 16.0%). Young adults with low 10-year but elevated 30-year predicted risk had an ASCVD incidence rate of 1.87 per 1,000 person-years compared with 0.32 per 1,000 person-years for those with low risk on both measures (age- and sex-adjusted IRR: 3.04). Only 1.0% of young adults had elevated 10-year risk, while 1.6% had low 10-year but elevated 30-year risk.

STUDY TYPE

cohort

SPECIALTY

cardiology

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AI pipeline

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ORIGINAL PAPER

PMC10251803

Incidence of Atherosclerotic Cardiovascular Disease in Young Adults at Low Short-Term But High Long-Term Risk

Journal of the American College of Cardiology

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ABSTRACT

BACKGROUND Young adults may have high long-term atherosclerotic cardiovascular disease (ASCVD) risk despite low short-term risk. OBJECTIVES In this study, we sought to compare the performance of short-term and long-term ASCVD risk prediction tools in young adults and evaluate ASCVD incidence associated with predicted short-term and long-term risk. METHODS We included adults aged 18 to 39 years, from 2008 to 2009 in a U.S. integrated health care system, and followed them through 2019. We calculated 10-year and 30-year ASCVD predicted risk and assessed ASCVD incidence. RESULTS Among 414,260 young adults, 813 had an incident ASCVD event during a median of 4 years (maximum 11 years). Compared with 10-year predicted risk, 30-year predicted risk improved reclassification (net reclassification index: 16%) despite having similar discrimination (Harrell’s C: 0.749 vs 0.726). Overall, 1.0% and 2.2% of young adults were categorized as having elevated 10-year (≥7.5%) and elevated 30-year (≥20%) predicted risk, respectively, and 1.6% as having low 10-year (<7.5%) but elevated 30-year predicted risk. The ASCVD incidence rate per 1,000 person-years was 2.60 (95% CI: 1.92–3.52) for those with elevated 10-year predicted risk, 1.87 (95% CI: 1.42–2.46) for those with low 10-year but elevated 30-year predicted risk, and 0.32 (95% CI: 0.30–0.35) for those with low 10-year and 30-year predicted risk. The age- and sex-adjusted incidence rate ratio was 3.04 (95% CI: 2.25–4.10) comparing those with low 10-year but elevated 30-year predicted risk and those with low 10-year and 30-year predicted risk. CONCLUSIONS Long-term ASCVD risk prediction tools further discriminate a subgroup of young adults with elevated observed risk despite low estimated short-term risk.

CITATION EXPORT

Jaejin An, Yiyi Zhang, Hui Zhou et al.. Incidence of Atherosclerotic Cardiovascular Disease in Young Adults at Low Short-Term But High Long-Term Risk. Journal of the American College of Cardiology. (2023). https://doi.org/10.1016/j.jacc.2022.11.051

AUTHORS

8 · 5 CENTRES

Jaejin An, Yiyi Zhang, Hui Zhou, Mengnan Zhou, Monika M. Safford, Paul Muntner, Andrew E. Moran, Kristi Reynolds

aDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
bDepartment of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
cDivision of General Medicine, Columbia University Irving Medical Center, New York, New York, USA
dDepartment of Medicine, Weill Cornell Medicine, New York, New York, USA
eDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.