Plaque buildup in young arteries may signal heart attack risk

Young adults with any amount of calcified plaque in their arteries are already at risk of a heart attack, a new study finds.

Among those 32 to 46 years old, even a little calcified plaque — called atherosclerosis, or hardening of the arteries — can boost the odds for fatal or nonfatal heart disease fivefold over the next 12 years, researchers found.

“Heart disease really begins in adolescence and early adulthood,” said lead researcher Dr. Jeffrey Carr.

Carr is a professor of radiology, biomedical informatics and cardiovascular medicine at Vanderbilt University in Nashville, Tenn.

For the study, CT scans, which can detect these potentially deadly blockages, were performed on more than 3,000 participants whose average age was 40.

Just a small amount of plaque increased the risk of heart attack over the next decade by 10 percent, regardless of other risk factors, the study authors said.

However, Carr explained, “We don’t think the message is for everybody to run out and get a CT scan.”

Still, people with red flags for heart disease at a young age — high blood pressure, high cholesterol, overweight or a smoker — might consider a CT scan to see if you are at a very high risk, he noted.

Another specialist agreed. Not enough evidence exists yet to recommend routine screening, said Dr. Philip Greenland, of Northwestern University Feinberg School of Medicine in Chicago.

But Greenland also recommended screening patients with known risk factors and addressing any abnormal findings.

“The fact that arterial blockages can occur in such young adults reinforces the need for much younger people — like teenagers and 20- to 30-year-olds — to follow healthy exercise and eating habits and not smoke,” said Greenland. He is a professor of preventive medicine and co-author of an editorial accompanying the study.

According to the American Heart Association, plaque consists of cholesterol, fatty substances, waste products from cells, calcium and fibrin (a clotting material in the blood).

Carr said that the appearance of early calcification is dependent on many factors, such as genetics, diet and lifestyle.

How to get rid of plaques isn’t known. But living a heart-healthy lifestyle might help, he and another heart specialist suggested.

“This study reinforces the idea that disease in the coronary arteries starts early, way before a heart attack actually occurs,” said Dr. Byron Lee of the University of California, San Francisco.

Even patients without symptoms may have an increased risk for heart attack, stroke and death, which should prompt them to lower the risk factors they can control, said Lee, who is a professor of medicine and chair of arrhythmia research at UCSF.

That means lowering blood pressure and cholesterol, maintaining a healthy weight, not smoking and eating a healthy diet, these experts said.

“Young, healthy patients who are on the fence about taking a statin drug to lower cholesterol might consider a cardiac CT to see if the disease process in their coronary arteries has already begun,” Lee added.

CT scan fees vary, from a few hundred dollars to several thousand dollars, depending on the type of scan and where it is done. Scans are often covered by insurance.

The report was published online Feb. 8 in the journal JAMA Cardiology.

For the study, Carr and colleagues collected data on more than 3,000 men and women who took part in the U.S. Coronary Artery Risk Development in Young Adults study.

These young and middle-aged adults underwent CT scans and were followed for more than 12 years. Thirty percent showed calcification of any amount, the findings showed.

During those 12 years, 57 participants had a fatal or nonfatal heart attack, or some other heart problem, or died from heart disease. In addition, 108 participants had a stroke or suffered from heart failure or circulatory problems, Carr said.

After taking into account other risk factors and treatments, people with any calcified plaque had a five times increase in their risk for cardiovascular problems. They also had a three times increase in their risk for a heart attack or stroke, the researchers found.

Whether the amount of calcification is high or low, Carr said it’s a signal that advanced coronary artery disease is present.