Impact of cardiovascular risk profiles on coronary plaque morphology: a cross-sectional study

Abstract Background Coronary artery disease remains a major global health challenge. Cardiovascular risk factors such as smoking, diabetes, dyslipidemia, hypertension and family history are the key points in the development and progression of the plaques. These factors are important for plaque morphology and play significant role in determining plaque stability and the risk of cardiovascular events. Understanding how these risk factors relate to plaque features can enhance risk stratification and inform therapeutic strategies. Purpose We aimed to investigate the relationship between various plaque parameters and risk factors in a single-center cohort study. Methods The assessment of a total of 305 patients who underwent coronary computed tomography angiography (CCTA) due to suspected CAD. Twenty patients were excluded due to low image quality. Each patient was assigned a risk score from 0 to 5, representing the total number of cardiovascular risk factors mentioned above. The statistical analysis in this study involved descriptive statistics and Spearman’s rank correlation to assess the relationship between risk factor burden, perivascular coronary artery tissue (PCAT), and plaque morphology features. Linear regression analyses were performed to analyze the associations between cardiovascular risk factors and various plaque characteristics. Results We investigated 285 participants. The mean age of the patients was 61.9 years (±9.9 years). A total of 776 coronary plaques were analyzed. The patient cohort consisted of 55.1% men. Spearman correlation analysis revealed a weak but statistically significant association between a higher risk factor burden and greater mean plaque burden (rho = 0.14, p < 0.001), larger plaque volume (rho = 0.1, p = 0.038), and increased fibrous volume (rho = 0.1, p = 0.044). Additionally, a negative correlation was observed between risk factor burden and remodeling index (rho = -0.1, p = 0.004), suggesting a shift toward more concentric plaque morphology. A weak but significant negative correlation (rho = -0.1, p = 0.029) was observed between PCAT density and lesion-dense calcium volume, indicating that more inflamed PCAT (less negative PCAT density) was associated with lower dense calcium volume in plaques. Smoking was a consistent and significant positive predictor of both lesion plaque volume (B = 21.40, p = 0.006) and lesion-dense calcium volume (B = 17.46, p = 0.001), while diabetes and dyslipidemia were significant positive predictors of obstruction plaque burden (p = 0.013 and p = 0.009, respectively). Conclusions Our analysis revealed a tendency for atherosclerotic plaque morphology is to be influenced by risk factors, emphasizing the importance of assessing both plaque characteristics and risk profile. Future, larger, and prospective analyses should address these findings identifying the precise atherosclerotic plaque morphology and risk profile that pose the highest risk for adverse cardiovascular events.