Age-specific determinants of coronary artery calcification: an age-stratified cohort analysis

Introduction

Coronary artery calcification reflects cumulative atherosclerotic burden and improves cardiovascular risk stratification beyond traditional risk factors. However, it remains unclear whether determinants of calcification differ according to age. Understanding age-specific risk profiles may refine preventive strategies and personalise clinical management.

Purpose

To evaluate the association between selected metabolic, inflammatory and genetic risk markers and coronary artery calcium score across different age groups.

Methods

We analysed 2,584 consecutive patients (63.9% women; median age 67 years) assessed between 2020 and 2025. Participants were stratified into three age groups: <50 years, 50–69 years and ≥70 years. Coronary artery calcium score was measured using non-contrast cardiac computed tomography. Laboratory assessment included lipid profile, fasting glucose, glycated haemoglobin, C-reactive protein, creatinine, ferritin and lipoprotein(a). Psychosocial factors (anxiety, depressive symptoms and sleep disturbances) were assessed using validated instruments. Correlation analyses were performed separately for each age group.

Results

In patients aged <50 years, fasting glucose showed a strong positive correlation with coronary artery calcium score (r=0.446; p<0.001).

In those aged 50–69 years, coronary artery calcium score correlated positively with C-reactive protein (r=0.306; p<0.001), creatinine (r=0.271; p=0.001), glycated haemoglobin (r=0.215; p=0.011) and ferritin (r=0.189; p=0.026).

In patients aged ≥70 years, significant positive correlations were observed for C-reactive protein (r=0.240; p=0.014) and lipoprotein(a) (r=0.327; p=0.001).

No significant associations were found between coronary artery calcium score and psychosocial parameters in any age category.

Conclusions

Determinants of coronary artery calcification vary substantially with age. Hyperglycaemia predominates in younger individuals, whereas metabolic and inflammatory factors are most relevant in middle age. In older adults, lipoprotein(a) and systemic inflammation show the strongest associations with calcification burden. These findings support age-tailored cardiovascular risk assessment and suggest that prevention strategies may need to consider life-stage–specific biological drivers of atherosclerosis progression.