Plaque Vulnerability and Cardiovascular Risk Factor Burden in Acute Coronary Syndrome: An Optical Coherence Tomography Analysis (JACC July 2025- 1)-Article: Plaque Vulnerability and Cardiovascular Risk Factor Burden in Acute Coronary Syndrome: An Optical Coherence Tomography Analysis

Article: Plaque Vulnerability and Cardiovascular Risk Factor Burden in Acute Coronary Syndrome: An Optical Coherence Tomography Analysis

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The study titled "Plaque Vulnerability and Cardiovascular Risk Factor Burden in Acute Coronary Syndrome: An Optical Coherence Tomography Analysis" explores the correlation between cardiovascular risk factors and plaque vulnerability in patients with acute coronary syndrome (ACS). Optical coherence tomography (OCT) was used to assess these plaques in 1,581 ACS patients, identifying both culprit and nonculprit lesions.<br /><br />The research focuses on the relationship between risk factor count—diabetes, hypertension, hyperlipidemia, and smoking—and plaque vulnerability, particularly in culprit lesions. It also examines the prevalence of lipid-rich plaques (LRPs), thin-cap fibroatheromas (TCFAs), macrophages, microvessels, and cholesterol crystals. The results indicate that a higher number of risk factors is significantly associated with increased vulnerability features, especially in culprit lesions.<br /><br />The findings suggest that the presence of two or more risk factors independently correlates with vulnerability markers except for LRPs. Furthermore, plaque rupture within culprit lesions showed an increased prevalence with more risk factors, suggesting a heightened risk in these patients, while plaque erosion tended toward a lower risk profile.<br /><br />The study underscores that cardiovascular risk factors amplify systemic and local inflammation, contributing to a more vulnerable plaque phenotype and poorer clinical outcomes. This understanding is crucial as it reinforces the importance of aggressive risk factor management in both primary and secondary prevention settings.<br /><br />While the study further elucidates the impact of risk factors on plaque vulnerability in ACS, it calls for further research to explore non-traditional risk factors, particularly concerning plaque erosion. This research emphasized the importance of a comprehensive approach towards managing cardiovascular risk to improve patient outcomes effectively.

Keywords

plaque vulnerability

cardiovascular risk factors

acute coronary syndrome

optical coherence tomography

culprit lesions

lipid-rich plaques

thin-cap fibroatheromas

plaque rupture

systemic inflammation

risk factor management