Modifiable Cardiovascular Risk Factors Linked to More Vulnerable Coronary Plaques

The burden of modifiable cardiovascular risk factors—not just the total number of risk factors—is strongly associated with greater coronary plaque vulnerability, suggesting that controlling these risk factors may help reduce the development of high-risk plaques. In this US study of 131 patients who underwent 3-vessel optical coherence tomography imaging, researchers analyzed 534 coronary plaques and evaluated the impact of both modifiable risk factors (dyslipidemia, high blood pressure, diabetes, obesity, and smoking) and non-modifiable risk factors (age, sex, and family history). As the total number of cardiovascular risk factors increased, patients had more coronary plaques, more high-risk thin-cap fibroatheromas (TCFAs), and a greater number of vulnerable plaque features, including thin fibrous caps, lipid-rich plaques, macrophage infiltration, microvessels, and cholesterol crystals. However, after adjusting for other factors, only a higher burden of modifiable risk factors remained independently associated with greater pan-coronary plaque vulnerability, including significantly higher rates of TCFAs, lipid-rich plaques, and cholesterol crystals. These findings highlight the critical importance of aggressively managing modifiable cardiovascular risk factors to reduce coronary plaque instability and potentially lower the risk of acute coronary syndromes. Source: https://www.jacc.org/