Coronary Plaque Burden in South Asian Adults: Insights From the DILWALE Registry

South Asian (SA) adults have disproportionately high rates of premature coronary artery disease, yet conventional risk calculators may not fully capture coronary plaque burden.

We analyzed the DILWALE (DIL Wellness and Arterial Health Longitudinal Evaluation) registry to quantify coronary plaque burden using computed tomography angiography (CTA) and compare it across risk categories using the 10-year atherosclerotic cardiovascular disease (ASCVD) risk calculator and American Heart Association PREVENT-ASCVD Calculator.

The DILWALE study is a medical record-based multicenter registry of SA adults (≥18 years) within Baylor Scott & White Health system. Patients who underwent clinically indicated coronary CTA were included and were risk stratified based on the PREVENT-ASCVD and Pooled Cohort Equations (PCE) risk scores. Quantitative plaque analysis was done using HeartFlow's plaque analysis tool to evaluate the association among PCE, PREVENT, and plaque burden.

A total of 341 SAs were included. Among individuals stratified by the PREVENT score, median total plaque volume rose from 0 mm³ in the low-risk group (<5% 10-year predicted ASCVD risk) to 34 mm³, 161 mm³, and 161 mm³ in the borderline- (5%-7.4%), intermediate- (7.5%-19.9%), and high-risk (≥20%) groups, respectively (P < 0.0001). In the PCE cohort, median total plaque volume increased from 1 mm³ in the low-risk group to 91 mm³, 122 mm³, and 215 mm³ in the borderline-, intermediate-, and high-risk groups, respectively (P < 0.0001).

In this SA cohort, higher PREVENT and ASCVD/PCE risk categories were associated with higher plaque burden. CTA reveals substantial noncalcified plaque missed by calcium scoring, underscoring its value for anatomic risk in SA adults.