The association of risk factors on coronary computed tomography angiography derived atherosclerotic plaque volume - Lessons from the ADVANCE registry

Background Diabetes mellitus, smoking, hypertension, and hyperlipidemia are well-studied cardiovascular risk factors (CVRF) for coronary artery disease (CAD). However, their combined and individual influence on atherosclerotic total plaque volume (TPV) and plaque subtypes as assessed by coronary computed tomographic angiography (CCTA) has not been well evaluated. Purpose To evaluate the association between CVRF on TPV and plaque subtypes and to develop quantitative plaque nomograms stratified by sex, age, and CVRF using CCTA findings. Methods This analysis included participants from the ADVANCE (Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care) registry. Quantitative assessment of TPV and plaque subtypes was performed using an Artificial Intelligence-Enabled Quantitative Coronary Plaque Analysis tool. Results A total of 4430 patients were included in the analysis, with a median age of 67.0 [59.0–73.0] years, and 1512 (34.1 %) were women. The median TPV was 390 mm 3 (IQR: 163–760 mm 3 ) and it was significantly higher in male participants (460 mm 3 ; IQR 197–855 mm 3 ) compared to female participants (280.5 mm 3 ; IQR: 118–583 mm 3 ) (P < 0.0001). Independent of sex, participants with CVRF had higher median TPVs (404.5 mm 3 ; IQR: 175–788.5 mm 3 ) than those without CVRF (187 mm 3 ; IQR: 74–431 mm 3 ) (P < 0.0001). On ROC analysis, age emerged as the strongest predictor of TPV >250 mm 3 (AUC 0.62; CI: 0.60–0.64), with only modest improvements in the model after adding male sex (0.67; CI: 0.65–0.69) and CVRF (0.69; CI: 0.68–0.71). Conclusions Our data indicate that TPV is significantly higher in participants with CVRF compared to those without. Age demonstrated the strongest association with plaque volume, while the addition of CVRF only modestly increased the AUC. Altogether, age and CVRF were only modestly associated with plaque volume, highlighting the need for further research to fully understand the potential and limitations of plaque imaging assessing the extent and severity of CAD, in patients with and without CVRF.