Association Between Cardiovascular Risk Factors and Pan-Coronary Plaque Burden, Phenotype, and Vulnerability: A 3-Vessel Imaging Study (JACC: Advances August 2026)-Article: Association Between Cardiovascular Risk Factors and Pan-Coronary Plaque Burden, Phenotype, and Vulnerability: A 3-Vessel Imaging Study

Article: Association Between Cardiovascular Risk Factors and Pan-Coronary Plaque Burden, Phenotype, and Vulnerability: A 3-Vessel Imaging Study

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This study examined whether cardiovascular risk factor burden is associated with the amount and “vulnerability” of coronary atherosclerosis across all 3 major coronary arteries using optical coherence tomography (OCT). The analysis included 131 patients without prior PCI and 534 plaques.<br /><br />Overall, as the number of cardiovascular risk factors increased, patients had more coronary plaques, more high-risk plaque types, and more vulnerable features. Vulnerable features included thin fibrous caps, lipid-rich plaques, macrophages, microvessels, and cholesterol crystals. The most vulnerable plaques were thin-cap fibroatheromas (TCFAs), which increased with rising risk factor burden, while stable fibrous plaques decreased.<br /><br />A key finding was the difference between modifiable and non-modifiable risk factors. Modifiable risk factors were dyslipidemia, hypertension, diabetes, obesity, and smoking. Non-modifiable factors were age, sex, and family history. In multivariable analysis, only modifiable risk factor burden was independently associated with greater pan-coronary vulnerability. It was linked to more TCFAs, more lipid-rich plaques, and more cholesterol crystals, as well as an overall shift toward a more dangerous plaque phenotype.<br /><br />By contrast, non-modifiable risk factor burden was associated with a greater total plaque burden, especially more fibrocalcific plaques, but was not independently linked to overall vulnerability.<br /><br />The authors conclude that cardiovascular risk factors, especially modifiable ones, are strongly associated with unfavorable coronary plaque biology across the entire coronary tree. These findings support aggressive prevention and treatment of modifiable risk factors to reduce future coronary event risk.

Meta Tag

Concept Cardiovascular Risk Factors

Concept Plaque Burden

Concept Optical Coherence Tomography

Concept Plaque Vulnerability

Concept Thin Fibrous Cap

Concept Lipid-Rich Plaque

Keywords

cardiovascular risk factors

coronary atherosclerosis

optical coherence tomography

plaque vulnerability

thin-cap fibroatheroma

modifiable risk factors

dyslipidemia

hypertension

lipid-rich plaques

cholesterol crystals

Cardiovascular Risk Factors

Plaque Burden

Optical Coherence Tomography

Plaque Vulnerability

Thin Fibrous Cap

Lipid-Rich Plaque