Abstract Body: Background: Coronary artery calcium (CAC) scoring, a noninvasive method for measuring subclinical atherosclerosis, is an early indicator of future cardiovascular events. Although biological/clinical risk factors for CAC are known, the role of behavioral and social determinants of health (SDOH) remains understudied in high-risk population such as those in Central Appalachian. Understanding how these determinants interact with CAC in Central Appalachia will uncover pathways that contribute to premature disease and widening health inequities. This study aims to examine the association between behavioral/SDOH and CAC among asymptomatic adults in the Appalachian region.
Methods: Electronic Health Records of patients screened for CAC using CT between 2019 and 2024 were acquired from a health system with 29 facilities across Central Appalachia. The CAC score was the outcome of the study and was assessed as follows: 0 = no CAC, 1-99 = mild CAC, 100-400 = moderate CAC, and >400 = severe CAC. In addition to clinical risk factors for CAC and medication use, data on health behaviors and SDOH were collected. Descriptive statistics and ordinal logistic regression analyses were conducted. We report results of summary statistics along with adjusted odds ratios (aORs), 95% confidence Intervals (CIs), and p-values with a significance ≤0.05 .
Results: A total of 8,300 asymptomatic patients with CAC scores were included in the analysis. Of these patients, 51.3% had a CAC score ≥1. For these individuals, mean CAC score was 128.12±128.85. Ordinal logistic regression results show that only health condition significantly associated with increased CAC score was BMI>30 [aOR=1.13, CI: 1.03-1.24]. Among health behaviors examined, smoking was significantly associated with CAC score [Current: aOR = 1.73, CI: 1.51-1.99; Former: aOR=1.40, CI: 1.26-1.55]. Although illicit drug use was positively associated with CAC score, it did not show any difference. Among the SDOH, while being a female significantly reduced the likelihood of a high CAC score by 56% compared to males [aOR=0.44; CI: 0.40-0.49]. Additionally, increasing age was associated with higher CAC score compared to patients aged <30 years.
Conclusion: Behavioral/SDOH such as smoking, obesity, and age remain strong drivers of CAC burden, highlighting an urgent need for regionally tailored equity-driven interventions that integrate SDOH screening, behavioral modification, and community-based prevention into cardiovascular care.