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Published on: January 28, 2020
Non-modifiable cardiovascular risk factors and coronary plaque characteristics in patients with acute coronary
Riccardo Scalamera1,2, Marco Covani3, Stefano Andreaggi1
1Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Insights
Non-modifiable risk factors (NMRFs) in acute coronary syndrome (ACS) patients do not predict plaque vulnerability or rupture. However, more NMRFs correlate with calcified plaques and less plaque erosion.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Imaging
Background:
- Cardiovascular risk factors are crucial in predicting adverse clinical outcomes, including acute coronary syndromes (ACS).
- Previous research linked modifiable risk factors to plaque vulnerability, but the impact of non-modifiable risk factors (NMRFs) remained unclear.
- Understanding NMRF influence on coronary plaque characteristics is vital for risk stratification.
Purpose of the Study:
- To investigate the correlation between the number of NMRFs and coronary plaque characteristics.
- To analyze plaque vulnerability and rupture prevalence in relation to NMRFs using optical coherence tomography (OCT).
Main Methods:
- Patients with ACS were categorized based on the number of NMRFs (age, sex, family history).
- Coronary plaques (culprit and non-culprit) were analyzed using OCT.
- Statistical analysis assessed the association between NMRF burden and plaque features, including vulnerability, rupture, calcification, and erosion.
Main Results:
- No significant association was found between the number of NMRFs and OCT-defined plaque vulnerability or rupture in culprit plaques.
- Similarly, non-culprit plaques showed no link between NMRFs and vulnerable features.
- A higher number of NMRFs was significantly correlated with increased calcified plaque prevalence (OR 2.60) and decreased plaque erosion (OR 0.72).
Conclusions:
- The burden of NMRFs is not associated with plaque vulnerability or rupture in patients with ACS.
- NMRFs are linked to a higher likelihood of calcified plaques and a lower likelihood of plaque erosion.
- These findings highlight specific plaque compositions associated with non-modifiable risk factors in ACS.
Aims:
Cardiovascular risk factors predict adverse clinical outcomes, including acute coronary syndromes (ACS). A recent study showed a close correlation between the number of modifiable risk factors and plaque vulnerability. However, the relationship between non-modifiable risk factors (NMRFs) and plaque characteristics has been unexplored. This study aimed to correlate the number of NMRFs with coronary plaque characteristics defined by optical coherence tomography (OCT).
Methods And Results:
Patients with ACS were divided into four groups based on the number of NMRFs (age ≥70 years, male sex, and family history of coronary artery disease). Lesion characteristics in both culprit and non-culprit plaques were analysed. A total of 2345 plaques (1663 culprit and 682 non-culprit plaques) were analysed. In culprit plaques, the prevalence of both OCT-defined vulnerable features and plaque rupture did not increase as the number of NMRFs increased (P-trend > 0.05 for each vulnerable feature and P-trend for plaque rupture: 0.856). In non-culprit plaques, no association between the number of NMRFs and vulnerable features was observed. However, the number of NMRF was directly correlated with calcified plaque (OR 2.60, 95% CI 2.01-3.37, P < 0.001) and inversely correlated with erosion (OR 0.72, 95% CI 0.61-0.84, P < 0.001).
Conclusion:
In patients with ACS, the burden of NMRFs was not correlated with OCT-defined plaque vulnerability or the prevalence of plaque rupture, both at culprit and non-culprit lesions. Conversely, a higher number of NMRF was linked to a greater probability of calcified plaque and a lower probability of plaque erosion.
Clinical Trial Registration:
Clinicaltrials.gov NCT01110538, NCT03479723, NCT04523194. https://www.umin.ac.jp/ctr/, UMIN000047254.
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