Abstract
Aims
Coronary artery calcium score (CACS) is widely used for cardiovascular risk stratification in asymptomatic population. We assessed the association of new blood pressure (BP) classification using the 2017 American College of Cardiology/American Heart Association guidelines with coronary artery calcification (CAC) progression according to age in asymptomatic adults.
Methods and Results
Overall, 10,839 asymptomatic Korean adults (23.4% aged ≤45 years) who underwent at least two CACS evaluations for health check-up were enrolled. Participants were categorised by age (≤45 and >45 years) and BP [normal (<120/<80 mmHg, untreated), elevated (120–129/<80 mmHg, untreated), stage 1 hypertension (untreated BP 130–139/80–89 mmHg) or stage 2 hypertension (BP ≥ 140/≥90 mmHg or antihypertensive use)] groups. CAC progression was defined as a difference of ≥ 2.5 between the square root (√) of the baseline and follow-up CACS. During a mean 3.3-year follow-up, the incidence of CAC progression was 13.5% and 36.3% in individuals aged ≤45 and >45 years, respectively. After adjustment for age, sex, diabetes, dyslipidaemia, obesity, current smoking and baseline CACS, hazard ratios (95% confidence interval) for CAC progression in elevated BP, stage 1 hypertension and stage 2 hypertension compared to normal BP were 1.43 (0.96–2.14)(P = 0.077), 1.64 (1.20–2.23)(P = 0.002) and 2.38 (1.82–3.12)(P < 0.001) in the ≤45 years group and 1.11 (0.95–1.30)(P = 0.179), 1.17 (1.04–1.32)(P = 0.009) and 1.52 (1.39–1.66)(P < 0.001) in the >45 years group, respectively.
Conclusion
Newly defined stage 1 hypertension is independently associated with CAC progression in asymptomatic adults regardless of age.