{"product_id":"silent-heart-disease-risk-how-age-and-sex-affect-early-plaque-buildup-in-healthy-asian-adults","title":"Silent Heart Disease Risk: How Age and Sex Affect Early Plaque Buildup in Healthy Asian Adults","description":"\u003cp\u003eIn a study of 663 healthy Asian adults without known heart disease or diabetes, researchers found that nearly 1 in 3 people (29.3%) already had detectable calcium buildup in their coronary arteries—a sign of early, silent atherosclerosis. The prevalence was more than twice as high in men (43.1%) than in women (18.0%), and it rose steeply with age, jumping from just 1.9% in people aged 30–39 to 66.3% in those aged 60 and older. Beyond age and sex, higher blood pressure, blood sugar, and LDL (\"bad\") cholesterol were all independently linked to the presence of these early plaques, with LDL cholesterol having a notably stronger association in women than in men. The findings suggest that heart disease prevention efforts may need to be personalized based on age and sex, even in people who currently feel perfectly healthy.\u003c\/p\u003e\n\n\u003ch1\u003eSilent Heart Disease Risk: How Age and Sex Affect Early Plaque Buildup in Healthy Asian Adults\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n  \u003cli\u003e\u003ca href=\"#background\"\u003eBackground: The Silent Early Stages of Heart Disease\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#study-methods\"\u003eStudy Methods: How the Research Was Conducted\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#key-findings\"\u003eKey Findings: What the Researchers Discovered\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#age-sex-differences\"\u003eAge and Sex Differences in Disease Burden\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#risk-factor-analysis\"\u003eWhich Risk Factors Matter Most?\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#risk-reclassification\"\u003eThe Impact on Risk Scoring and Prevention\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#comparison\"\u003eHow These Results Compare With Other Studies\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#limitations\"\u003eStudy Limitations: What This Research Couldn't Prove\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations: What This Means for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eIn 663 healthy Asian adults without heart disease or diabetes, 29.3% had silent coronary artery calcium.\u003c\/li\u003e\n\u003cli\u003eMen had over twice the prevalence of plaque as women: 43.1% versus 18.0%.\u003c\/li\u003e\n\u003cli\u003ePrevalence rose steeply with age, from 1.9% at ages 30-39 to 66.3% at ages 60 and older.\u003c\/li\u003e\n\u003cli\u003eIndependent risk factors for any plaque were age, male sex, systolic blood pressure, glucose, and LDL cholesterol.\u003c\/li\u003e\n\u003cli\u003eLDL cholesterol was significantly more associated with plaque in women than in men; CAC score reclassified 5.56% to elevated risk.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eBackground: The Silent Early Stages of Heart Disease\u003c\/h2\u003e\n\n\u003cp\u003eAtherosclerosis—the progressive buildup of fat, inflammation, scar tissue, and calcium inside artery walls—is a long and complex process that often begins early in life. For many people, this process goes completely unnoticed for decades because it produces no symptoms until it has advanced significantly. By the time someone experiences chest pain, a heart attack, or a stroke, the disease has typically been developing silently for years.\u003c\/p\u003e\n\n\u003cp\u003eThis has led to a major shift in cardiovascular medicine toward what doctors call \u003cstrong\u003e\"primordial prevention\"\u003c\/strong\u003e—identifying and addressing risk factors before the disease even takes hold. The logic is simple: if we can detect atherosclerosis in its earliest, preclinical (pre-symptomatic) stage, we may be able to intervene and stop it from ever progressing to a clinical event.\u003c\/p\u003e\n\n\u003cp\u003eThe influence of age and sex on full-blown coronary artery disease (CAD) is well established in medical literature. Epidemiological, clinical, and experimental studies have consistently shown sex-specific differences in how heart disease develops, how it presents, and how it progresses. Women, for example, tend to develop clinical CAD about 10 years later than men on average. Prevention and treatment outcomes also differ significantly across age groups and between sexes.\u003c\/p\u003e\n\n\u003cp\u003eWhat has been less clear, however, is whether these age and sex differences extend to the very earliest, preclinical stage of the disease—before any symptoms appear. This question carries important implications for screening programs and early prevention strategies designed for asymptomatic individuals.\u003c\/p\u003e\n\n\u003cp\u003eTo study this, researchers turned to a well-established tool: the \u003cstrong\u003ecoronary artery calcium (CAC) score\u003c\/strong\u003e. This is a highly specific and validated marker of subclinical (pre-symptomatic) coronary atherosclerosis, with consistent evidence linking CAC levels to major cardiovascular outcomes. In this study, the researchers used CAC scoring to measure the extent of early plaque in a healthy Asian population, examining how age and sex influence the burden of this silent disease.\u003c\/p\u003e\n\n\u003ch2 id=\"study-methods\"\u003eStudy Methods: How the Research Was Conducted\u003c\/h2\u003e\n\n\u003cp\u003eThis research was part of the \u003cstrong\u003eSingHEART study\u003c\/strong\u003e, a prospective, population-based study of healthy Asian adults living in Singapore. The study was designed to evaluate how cardiovascular disease develops among asymptomatic healthy individuals, with participants recruited from the general population between October 2015 and July 2020.\u003c\/p\u003e\n\n\u003cp\u003eTo be included in the study, participants had to meet specific criteria:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eNo known history of any prior cardiovascular disease, including ischemic heart disease, stroke, or peripheral vascular disease\u003c\/li\u003e\n  \u003cli\u003eNo known history of cancer, autoimmune or genetic diseases, endocrine diseases, diabetes mellitus, psychiatric illness, asthma, chronic lung disease, or chronic infectious diseases\u003c\/li\u003e\n  \u003cli\u003eNo family medical history of cardiomyopathies\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eParticipants completed standardized questionnaires covering demographics, lifestyle factors, and medical history. Clinical measurements were taken for height, weight, and blood pressure, and fasting blood samples were collected to measure lipid (fat) levels and glucose (sugar). Written informed consent was obtained from all volunteers, and the study received approval from the institutional ethics review board (SingHealth CIRB ref: 2015\/2601).\u003c\/p\u003e\n\n\u003cp\u003eAll subjects aged 30 years and older underwent a single CAC assessment at baseline. The scans were performed using a 320 × 0.5 mm detector row CT system (Canon Medical Systems) with prospective ECG triggering—a technique that synchronizes the scan with the heart's rhythm to produce the clearest images. The scans covered a single heartbeat with a gantry rotation and x-ray exposure time of 0.35 seconds and 0.5 mm slice collimation.\u003c\/p\u003e\n\n\u003cp\u003eCAC scores were calculated using the \u003cstrong\u003eAgatston method\u003c\/strong\u003e, a standardized scoring system named after its developer, Arthur Agatston. Scores were classified into standard categories:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003e0\u003c\/strong\u003e – No calcified plaque present\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003e1 to 10\u003c\/strong\u003e – Minimal plaque\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003e11 to 100\u003c\/strong\u003e – Mild plaque\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003e\u0026gt;100\u003c\/strong\u003e – Moderate to severe plaque\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe researchers also used the \u003cstrong\u003eMESA (Multi-Ethnic Study of Atherosclerosis) coronary heart disease (CHD) risk score\u003c\/strong\u003e to classify participants by cardiovascular risk. This algorithm incorporates traditional risk factors to predict the 10-year risk of developing coronary heart disease. Two versions of the score were generated: one relying on traditional Framingham risk variables, and another that additionally incorporates the CAC score. A 10-year risk score of less than 7.5% was considered \"low,\" while a score of 7.5% or higher was considered \"elevated,\" following general ACC\/AHA cardiovascular risk assessment guidelines.\u003c\/p\u003e\n\n\u003ch2 id=\"key-findings\"\u003eKey Findings: What the Researchers Discovered\u003c\/h2\u003e\n\n\u003cp\u003eA total of 800 participants were initially recruited for the study. Of these, 135 (16.8%) were younger than 30 years and did not undergo CT evaluation, and an additional 2 people refused the CT scan. This left a final study population of \u003cstrong\u003e663 individuals\u003c\/strong\u003e.\u003c\/p\u003e\n\n\u003cp\u003eThe average age of participants was \u003cstrong\u003e49.4 ± 9.2 years\u003c\/strong\u003e, and \u003cstrong\u003e297 (44.8%) were men\u003c\/strong\u003e. All participants had normal kidney function, with an estimated glomerular filtration rate (eGFR) above 55 mL\/min\/1.73 m².\u003c\/p\u003e\n\n\u003cp\u003eThe overall prevalence of any coronary artery calcium (defined as a CAC score greater than 0) was \u003cstrong\u003e29.3%\u003c\/strong\u003e (95% CI: 25.8%–32.9%). Breaking this down by severity:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003e47 people (7.1%)\u003c\/strong\u003e had CAC scores between 1 and 10 (minimal plaque)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003e87 people (13.1%)\u003c\/strong\u003e had CAC scores between 10 and 100 (mild plaque)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003e60 people (9.0%)\u003c\/strong\u003e had CAC scores greater than 100 (moderate to severe plaque)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003e17 people (2.6%)\u003c\/strong\u003e had CAC scores greater than 400 (extensive plaque)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eWhen comparing people with any CAC to those without any calcium buildup, the differences were striking. People with CAC were significantly more likely to be older, to be men, and to have higher systolic blood pressure, diastolic blood pressure, fasting glucose, total cholesterol, LDL cholesterol, and triglyceride levels—all with statistical significance of P \u0026lt; 0.001.\u003c\/p\u003e\n\n\u003cp\u003eAmong those who did have CAC, participants who were older, male, and smokers were more likely to have moderate-to-severe plaque (CAC \u0026gt; 100) rather than milder forms.\u003c\/p\u003e\n\n\u003ch3\u003eKey Numbers at a Glance\u003c\/h3\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003e29.3%\u003c\/strong\u003e – Prevalence of any coronary artery calcium in the overall population\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003e43.1% vs 18.0%\u003c\/strong\u003e – Prevalence in men vs women (P \u0026lt; 0.001)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003e1.9% to 66.3%\u003c\/strong\u003e – Prevalence range from age 30–39 to age ≥60\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003e9.0%\u003c\/strong\u003e – Percentage with moderate-to-severe plaque (CAC \u0026gt; 100)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch2 id=\"age-sex-differences\"\u003eAge and Sex Differences in Disease Burden\u003c\/h2\u003e\n\n\u003cp\u003eOne of the most significant findings was how dramatically the prevalence of CAC increased with age. Across the entire population, the rate of any CAC rose from just \u003cstrong\u003e1.9% in people aged 30–39\u003c\/strong\u003e to \u003cstrong\u003e17.8% in those aged 40–49\u003c\/strong\u003e, then to \u003cstrong\u003e36.0% in those aged 50–59\u003c\/strong\u003e, and finally to \u003cstrong\u003e66.3% in those aged 60 and older\u003c\/strong\u003e (P \u0026lt; 0.001 for trend).\u003c\/p\u003e\n\n\u003cp\u003eSex differences were equally pronounced. Men had more than double the prevalence of any CAC compared to women: \u003cstrong\u003e43.1% vs 18.0%\u003c\/strong\u003e (P \u0026lt; 0.001). This pattern held across all severity categories:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCAC 1–10:\u003c\/strong\u003e 9.4% of men vs 5.2% of women (P = 0.035)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCAC 10–100:\u003c\/strong\u003e 17.8% of men vs 9.3% of women (P = 0.001)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCAC \u0026gt;100:\u003c\/strong\u003e 15.8% of men vs 3.6% of women (P \u0026lt; 0.001)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003ePerhaps most revealing was the difference in \u003cem\u003ewhen\u003c\/em\u003e moderate-to-severe disease began to appear. In men, the prevalence of moderate-to-severe CAC (scores \u0026gt;100) started rising noticeably from age 40 onward, reaching 5.6% in the 40–49 age group, 17.2% in the 50–59 group, and a striking 44.9% in men aged 60 and older.\u003c\/p\u003e\n\n\u003cp\u003eIn women, the pattern was different. Moderate-to-severe CAC remained quite low through middle age—just 1.6% in the 40–49 group and 1.5% in the 50–59 group—before jumping to 18.4% in women aged 60 and older. This delayed rise in women aligns with a well-established clinical observation: significant coronary artery disease often occurs about 10 years later in women than in men, likely related to the loss of protective effects of estrogen after menopause.\u003c\/p\u003e\n\n\u003cp\u003eThe researchers noted that this age gap, long known in clinical heart disease, extends all the way back to the preclinical stage—meaning the biological processes driving sex differences begin much earlier than when symptoms first appear.\u003c\/p\u003e\n\n\u003ch2 id=\"risk-factor-analysis\"\u003eWhich Risk Factors Matter Most?\u003c\/h2\u003e\n\n\u003cp\u003eThe researchers used multivariable logistic regression models to determine which clinical factors were independently associated with the presence of coronary artery calcium. These models were carefully adjusted for a fixed set of traditional cardiovascular risk factors: age, sex, smoking, sedentary behavior (defined by participant occupation), body mass index (BMI), systolic blood pressure, glucose, LDL cholesterol, and HDL cholesterol.\u003c\/p\u003e\n\n\u003cp\u003eAfter adjustment, five factors emerged as \u003cstrong\u003eindependently associated with the presence of any CAC\u003c\/strong\u003e:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAge:\u003c\/strong\u003e each additional year increased the odds by 13% (OR: 1.13; 95% CI: 1.10–1.17)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eMale sex:\u003c\/strong\u003e men had 3.45 times higher odds compared to women (OR: 3.45; 95% CI: 2.19–5.43)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSystolic blood pressure:\u003c\/strong\u003e each additional mmHg increased odds by 2% (OR: 1.02; 95% CI: 1.01–1.03)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eGlucose level:\u003c\/strong\u003e each additional mmol\/L increased odds by 44% (OR: 1.44; 95% CI: 1.04–1.99)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eLDL cholesterol:\u003c\/strong\u003e each additional mmol\/L increased odds by 38% (OR: 1.38; 95% CI: 1.08–1.78)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eWhen looking at different levels of CAC severity, the associations varied. Increasing age and male sex were significantly associated with \u003cem\u003eall\u003c\/em\u003e degrees of CAC severity. But other factors showed more specific patterns:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eLDL cholesterol\u003c\/strong\u003e was associated with minimal plaque (CAC 1–10; OR: 1.60; 95% CI: 1.09–2.35)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSystolic blood pressure\u003c\/strong\u003e and \u003cstrong\u003eglucose\u003c\/strong\u003e were associated with mild plaque (CAC 10–100; OR: 1.02 and 1.56, respectively)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSystolic blood pressure\u003c\/strong\u003e and \u003cstrong\u003eglucose\u003c\/strong\u003e were also associated with moderate-to-severe plaque (CAC \u0026gt;100; with glucose showing an OR of 2.04; 95% CI: 1.20–3.46)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eNotably, \u003cstrong\u003esmoking and BMI were not associated with CAC\u003c\/strong\u003e in the multivariable models. The researchers suggested this could be explained by the very low rates of smoking (7.69%) and obesity (5.3%) in this unusually healthy population. Similarly, HDL (\"good\") cholesterol was not associated with CAC—a finding consistent with recent evidence questioning whether absolute HDL levels are reliably predictive of cardiovascular outcomes in all populations.\u003c\/p\u003e\n\n\u003ch3\u003eA Key Sex Difference: LDL Cholesterol Affects Women More\u003c\/h3\u003e\n\n\u003cp\u003eOne of the most interesting findings involved how risk factors differed between men and women. When the researchers analyzed data separately by sex, they found that in \u003cstrong\u003emen, age was the only factor independently associated with any CAC\u003c\/strong\u003e (OR: 1.13; 95% CI: 1.09–1.18).\u003c\/p\u003e\n\n\u003cp\u003eIn \u003cstrong\u003ewomen\u003c\/strong\u003e, however, the picture was broader. After multivariable adjustment, \u003cstrong\u003eage, smoking, sedentary behavior, systolic blood pressure, and LDL cholesterol\u003c\/strong\u003e were all independently associated with the presence of any CAC.\u003c\/p\u003e\n\n\u003cp\u003eSpecific numbers for women:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSmoking:\u003c\/strong\u003e OR 4.74 (95% CI: 1.09–20.7) in multivariate analysis\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSystolic blood pressure:\u003c\/strong\u003e OR 1.03 (95% CI: 1.01–1.05)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eLDL cholesterol:\u003c\/strong\u003e OR 2.00 (95% CI: 1.44–3.00)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eFormal interaction testing confirmed that LDL cholesterol was significantly more associated with CAC in women than in men (adjusted P for interaction = 0.022). This is noteworthy because traditionally, LDL cholesterol has been thought to carry a greater atherogenic (plaque-causing) risk in men than women. The researchers proposed two possible explanations for this surprising reversal.\u003c\/p\u003e\n\n\u003cp\u003eFirst, over half of the female participants were aged 50 years or older, meaning many were likely postmenopausal. The loss of estrogen's protective effects on traditional cardiovascular risk factors could amplify the impact of LDL cholesterol in older women. Second, there may have been a form of selection bias: older men with high-risk lipid profiles might have already developed clinical heart disease and therefore been excluded from this \"healthy\" population, whereas comparable women—whose disease typically manifests later—would still qualify for the study.\u003c\/p\u003e\n\n\u003cp\u003eThe researchers also acknowledged that atherosclerosis is a complex process, and sex-specific differences extend beyond lipids to include differences in systemic and vascular inflammation, as well as the role of sex hormones in modulating immune responses. These inflammatory mechanisms may contribute to different atherosclerotic phenotypes across sexes, though research on this remains limited.\u003c\/p\u003e\n\n\u003ch2 id=\"risk-reclassification\"\u003eThe Impact on Risk Scoring and Prevention\u003c\/h2\u003e\n\n\u003cp\u003eAn important practical question is whether measuring CAC actually changes how doctors assess a patient's risk. To explore this, the researchers calculated each participant's 10-year coronary heart disease risk using the MESA risk score—both with and without incorporating their CAC score.\u003c\/p\u003e\n\n\u003cp\u003eThey found that participants with higher CAC scores indeed had higher 10-year CHD risk scores (Fisher's exact P \u0026lt; 0.001). Specifically:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003e16.7% of participants with CAC \u0026gt;100\u003c\/strong\u003e had 10-year CHD risk scores of 5% or higher\u003c\/li\u003e\n  \u003cli\u003eIn contrast, only \u003cstrong\u003e1.5% of participants with a CAC score of 0\u003c\/strong\u003e had risk scores at that level (P \u0026lt; 0.001)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eAfter incorporating CAC scores into the risk calculation, there was a significant increase in the mean 10-year CHD risk score for the entire population, from 1.78% to 2.20% (P \u0026lt; 0.001). More importantly, the researchers observed significant \u003cstrong\u003ereclassification of individual risk\u003c\/strong\u003e: \u003cstrong\u003e35 individuals (5.56% of the cohort)\u003c\/strong\u003e were moved from a \"low\" risk category to an \"elevated\" risk category after their CAC scores were considered (P \u0026lt; 0.001).\u003c\/p\u003e\n\n\u003cp\u003eThis reclassification matters because these individuals might otherwise have fallen below typical thresholds for cardiovascular risk factor monitoring. In other words, without a CAC scan, they would not have been flagged for more aggressive preventive measures—even though they had silent plaque buildup that significantly raises their actual risk.\u003c\/p\u003e\n\n\u003ch2 id=\"comparison\"\u003eHow These Results Compare With Other Studies\u003c\/h2\u003e\n\n\u003cp\u003eThe prevalence of 29.3% found in this study aligns closely with rates reported in other large studies of similar populations:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eThe \u003cstrong\u003eMESA study\u003c\/strong\u003e reported a prevalence of 33.7% in its nondiabetic, healthy subset—though it's worth noting the MESA cohort had a higher mean age (62 years) than the SingHEART population (49.4 years)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eLee et al.\u003c\/strong\u003e reported 34% prevalence (mean age 53.8 years)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eVan Wagner et al.\u003c\/strong\u003e reported 27.1% prevalence (mean age 50.1 years)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eKim et al.\u003c\/strong\u003e reported 31.1% prevalence (mean age 54 years)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe patterns of higher disease burden in men and increasing prevalence with age in both sexes have been observed not only at the level of clinical CAD but also at the preclinical level, using both CAC scores and carotid intima-media thickness (ultrasound measurements of artery wall thickness) in other populations.\u003c\/p\u003e\n\n\u003cp\u003eThese comparative data are especially valuable given the relative scarcity of population-based data on preclinical atherosclerosis in Asian populations—despite Asia rapidly becoming a global epicenter for cardiovascular disease. The consistency of findings across different countries and ethnicities strengthens confidence in the generalizability of the results.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eStudy Limitations: What This Research Couldn't Prove\u003c\/h2\u003e\n\n\u003cp\u003eLike all scientific studies, this research has important limitations that should be considered when interpreting the results.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e1. Cross-sectional design.\u003c\/strong\u003e This was a cross-sectional study, meaning all measurements were taken at a single point in time. The researchers could identify associations between risk factors and the presence of CAC, but they could not establish causality or track how the disease progressed over time. Longitudinal follow-up of these participants will be needed to understand how early plaques evolve.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e2. \"Healthy\" population selection.\u003c\/strong\u003e The inclusion criteria were intentionally strict—excluding anyone with diabetes, prior cardiovascular disease, cancer, and many other conditions. While this was necessary to study the earliest stages of disease, it means the results may not apply to the broader population, including people with existing health conditions.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e3. Low prevalence of certain risk factors.\u003c\/strong\u003e The very low rates of smoking (7.69%) and obesity (5.3%) in this cohort may have limited the statistical power to detect associations between these factors and CAC. The lack of association between smoking or BMI and CAC should not be interpreted as proof that these factors are harmless.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e4. Limited diversity.\u003c\/strong\u003e The study population was entirely Asian, living in Singapore. While this fills an important research gap, the findings may not directly translate to other ethnic groups.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e5. Possible selection bias.\u003c\/strong\u003e As the researchers themselves noted, the design of enrolling \"healthy\" individuals may have inadvertently excluded older men with high-risk lipid profiles who had already developed clinical disease, while including comparable women whose disease typically manifests later. This could influence the sex-specific comparisons.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e6. No inflammatory markers.\u003c\/strong\u003e The study did not comprehensively assess inflammatory markers or sex hormone levels—factors that may play important roles in the sex differences observed but were not measured.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e7. MESA risk score thresholds.\u003c\/strong\u003e The researchers noted that stratification thresholds specific to the MESA risk score have not yet been fully established, so the use of the 7.5% cutoff (borrowed from ACC\/AHA guidelines) may not be perfectly calibrated for all populations.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations: What This Means for Patients\u003c\/h2\u003e\n\n\u003cp\u003eThis study provides several practical messages for patients and their doctors, particularly for those of Asian descent:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSilent disease is common, even in \"healthy\" people.\u003c\/strong\u003e Nearly one-third of people with no symptoms, no diabetes, and no known heart disease had measurable plaque in their coronary arteries. Feeling healthy does not guarantee that your arteries are healthy.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAge matters—a lot.\u003c\/strong\u003e The dramatic jump in prevalence from 1.9% in the 30s to 66.3% by age 60 highlights that atherosclerosis accumulates steadily over time. This supports the concept of starting cardiovascular risk assessment early in adulthood, not waiting until symptoms appear.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eMen and women have different risk curves.\u003c\/strong\u003e Men show significant plaque buildup starting in their 40s, while women tend to catch up only after age 60. For women, maintaining control of modifiable risk factors—particularly LDL cholesterol and blood pressure—may be especially important in the postmenopausal years.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eTraditional risk factors predict early disease.\u003c\/strong\u003e The associations between blood pressure, glucose, LDL cholesterol, and CAC confirm that even at the preclinical stage, the same risk factors that drive clinical heart disease are already at work. This reinforces the importance of regular checkups that measure blood pressure and fasting blood work, even when you feel well.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eLDL cholesterol may deserve special attention in women.\u003c\/strong\u003e The finding that LDL had a stronger association with plaque in women than men (P for interaction = 0.022) suggests that women's cholesterol levels should be managed with at least as much rigor as men's—if not more.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCAC scoring can reclassify risk.\u003c\/strong\u003e More than 1 in 20 participants (5.56%) were reclassified from low to elevated risk after a CAC scan. For individuals whose risk falls in a borderline zone based on traditional factors alone, a CAC scan may provide valuable information that changes preventive treatment decisions—such as whether to start a statin.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePrevention is the most powerful tool.\u003c\/strong\u003e Because early atherosclerosis is detectable and its risk factors are modifiable, lifestyle measures and, where appropriate, medications can potentially slow or halt the progression from silent plaque to clinical heart disease. The strong evidence supporting statin therapy for primary prevention, including its anti-inflammatory effects, is particularly relevant given the LDL findings in this study.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eThe researchers emphasized that this study was designed not to alarm healthy people but to better inform \u003cstrong\u003eindividualized future risk management strategies\u003c\/strong\u003e. By understanding how age and sex shape the earliest stages of atherosclerosis, doctors may be better equipped to prevent the development and progression of coronary artery disease within individuals who currently have no signs of trouble.\u003c\/p\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat did this study measure, and in whom?\u003c\/h3\u003e\n\u003cp\u003eThe study used coronary artery calcium (CAC) scans to look for silent plaque buildup in 663 healthy Asian adults aged 30 and older without known heart disease or diabetes. Overall, 29.3% had detectable calcium. Researchers examined how age and sex affected the likelihood of having this early sign of atherosclerosis.\u003c\/p\u003e\n\u003ch3\u003eHow much more common was silent plaque in men than in women?\u003c\/h3\u003e\n\u003cp\u003eIn this healthy Asian population, 43.1% of men had detectable coronary artery calcium, compared with 18.0% of women. Men also had higher rates of moderate-to-severe plaque. The sex difference appeared early: men showed significant plaque from their 40s, while women caught up only after age 60.\u003c\/p\u003e\n\u003ch3\u003eHow did age affect the chances of having silent plaque?\u003c\/h3\u003e\n\u003cp\u003eAge strongly influenced plaque prevalence. Among people aged 30-39, only 1.9% had any coronary calcium. This rose to 17.8% at ages 40-49, 36.0% at ages 50-59, and 66.3% at age 60 and older. The study authors suggested cardiovascular risk assessment should start early in adulthood, not wait for symptoms.\u003c\/p\u003e\n\u003ch3\u003eWhich traditional risk factors were linked to silent plaque?\u003c\/h3\u003e\n\u003cp\u003eAfter adjusting for other factors, older age, male sex, higher systolic blood pressure, higher fasting glucose, and higher LDL cholesterol were each independently associated with having any coronary calcium. Smoking and BMI were not linked in this particular healthy group, possibly because very few participants smoked or were obese.\u003c\/p\u003e\n\u003ch3\u003eDid LDL cholesterol affect men and women differently?\u003c\/h3\u003e\n\u003cp\u003eYes. In women, higher LDL cholesterol was independently linked to silent plaque, with an odds ratio of 2.00 per mmol\/L. In men, age was the only independent factor. Formal testing showed LDL was significantly more associated with plaque in women than in men, suggesting women's cholesterol levels deserve at least as much attention as men's.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eOriginal article title:\u003c\/strong\u003e Impact of Age and Sex on Subclinical Coronary Atherosclerosis in a Healthy Asian Population\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Mark Yu Zheng Wong, Jonathan Yap, MD, Weiting Huang, MD, Swee Yaw Tan, MD, Khung Keong Yeo, MD (Drs. Wong and Yap contributed equally to this work)\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eJournal:\u003c\/strong\u003e JACC: Asia, Vol. 1, No. 1, 2021, pages 93–102\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublication date:\u003c\/strong\u003e June 2021 (manuscript received April 18, 2021; revised May 3, 2021; accepted May 3, 2021)\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAffiliations:\u003c\/strong\u003e Department of Cardiology, National Heart Centre Singapore; School of Clinical Medicine, University of Cambridge, United Kingdom; Duke-NUS Medical School, Singapore\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eDOI:\u003c\/strong\u003e https:\/\/doi.org\/10.1016\/j.jacasi.2021.05.002\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFunding\/Disclosures:\u003c\/strong\u003e The authors stated they are in compliance with human studies committees and animal welfare regulations, including patient consent where appropriate.\u003c\/p\u003e\n\n\u003cp\u003e\u003cem\u003eThis patient-friendly article is based on peer-reviewed research. It is intended for educational purposes and should not replace professional medical advice. Always consult your healthcare provider about your personal cardiovascular risk and preventive strategies.\u003c\/em\u003e\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47423011455132,"sku":null,"price":0.0,"currency_code":"JPY","in_stock":true}],"url":"https:\/\/diagnosticdetectives.jp\/products\/silent-heart-disease-risk-how-age-and-sex-affect-early-plaque-buildup-in-healthy-asian-adults","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}