Association of traditional cardiovascular risk factors with coronary plaque sub-types assessed by 64-slice computed tomography angiography in a large cohort of asymptomatic subjects
Introduction
Traditional cardiovascular risk stratification tools tend to underestimate cardiovascular event risk, especially in women and in young individuals [1], [2]. Given that a significant number of individuals who experience a first myocardial infarction (MI) did not have chest pain or any clinical evidence of coronary artery disease (CAD) prior to the event, early disease detection becomes an important element of cardiovascular prevention efforts [3].
Quantification of coronary arterial calcification (CAC) provides prognostic information beyond identification of traditional CV risk factors [4], [5]. Although the CAC score correlates well with disease burden, calcified plaques (CAP) only represent a portion of the total atherosclerosis plaque burden [6]. The residual atherosclerotic burden is composed of pure non-calcified (NCAP) coronary plaques or mixed (MCAP) with some calcified component. Previous reports have suggested that coronary NCAPs are associated, more so than CAPs, with acute coronary syndrome [7], [8]. In addition, MCAPs have been associated with the presence of severe perfusion defects by single-photon emission computed tomography [9].
The use of 64-slice coronary computed tomography angiography (CCTA) has been validated as a sensitive and specific tool not only for the detection of significant coronary stenosis [10], [11], [12], [13] but also for defining plaque morphology and plaque outward expansion [14], [15], factors that could potentially play a role in the degree of plaque vulnerability. There is a paucity of data regarding the association of plaque morphology, or plaque sub-type, with the presence of traditional CV risk factors. The purpose of this study is to investigate this association in a large cohort of asymptomatic subjects without a history of CAD.
Section snippets
Study population
We did a retrospective sub-analysis of 1074 consecutive South Korean individuals who underwent CCTA evaluation using 64-slice multidetector computed tomography (MDCT) as part of a general routine health evaluation in the Seoul National University Bundang Hospital (SNUBH) between December 2005 and May 2006. An initial cross-sectional evaluation of this subject population has been published elsewhere [16]. For the present analysis, we excluded 59 subjects who had chest pain or discomfort prior to
Characteristics of study population
Our cohort consisted of 1015 asymptomatic South Korean individuals who had no history of CAD. The study population characteristics are outlined in Table 1. The mean age was 53 ± 10 years and 64% were males. Mean lipid parameters were within normal limits (LDL-C 117 ± 32 mg/dl, HDL-C 60 ± 13 mg/dl, and triglycerides 133 ± 89 mg/dl). A significant percent (34%) of study participants were smokers and 20% were hypertensive. Overall, the cohort had a low risk for the development of future cardiovascular events.
Discussion
To the best of our knowledge, this is the first study that reports on the association of traditional CV risk factors with coronary plaque sub-types, using 64-slice CCTA, in a large cohort of exclusively asymptomatic individuals without a history of CAD. The main findings are the following: (1) age and male gender were overall the strongest predictors for the presence of CAP and MCAP; they were also the strongest predictors for the presence of ≥2 coronary segments with CAP and MCAP; (2) male
Conclusions
Age and gender are overall the strongest predictors of atherosclerosis and are not exclusively associated with the presence of any of the different plaque sub-types. Smoking is strongly associated with the extent of coronary NCAPs, a type of plaque which has been associated with vulnerability and acute events. These findings should be corroborated on other ethnic groups. Although the use of CCTA for the characterization of plaque morphology is promising and could potentially lead to future risk
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2015, Revista Brasileira de Cardiologia InvasivaAbsolute coronary artery calcium score is the best predictor of non-calcified plaque involvement in patients with low calcium scores(1-100)
2013, AtherosclerosisCitation Excerpt :The present study demonstrates a graded relationship between the absolute CAC score and NCP burden in patients with low CAC scores (1–100) after adjustment for other variables. Multiple efforts have been devoted to find the best predictor of non-calcified plaque including epicardial adipose tissue volume [9], hypercholesterolemia [10], adiponectin level [11], diabetes [10] and smoking [12]. Our results suggest that the absolute calcium score is the best predictor of NCP burden in patients with low CAC scores.
Association between family history of premature coronary artery disease and coronary atherosclerotic plaques shown by multidetector computed tomography coronary angiography
2013, International Journal of CardiologyCitation Excerpt :In a study by Bamberg et al. [16] FH of premature CAD was statistically significantly associated with the extent of non-calcified CAP, as analyzed using a multivariate linear regression model. However, in the study by Rivera et al. [17] FH of premature CAD was not a significant predictor of the extent of non-calcified CAP in a large cohort of asymptomatic subjects without any cardiovascular disease. Furthermore in a study by Faletra et al. [18], FH of premature CAD was not associated with the presence of CAP in a group of patients with suspected CAD.
Impact of family history of coronary artery disease in young individuals (from the CONFIRM registry)
2013, American Journal of CardiologyCitation Excerpt :These data generally agree with those of Sunman et al,19 who examined 349 patients (mean age 58 ± 11 years), of whom 168 reported FH of CAD, and reported higher prevalences of CAD and noncalcified plaque in FH+ than FH− patients. In contrast, Rivera et al20 reported in 1,015 asymptomatic patients (mean age 53 ± 10 years) FH+ state in 131 and observed no significant association with the presence of any CAD in FH+ subjects. Given these discordant results, our study findings directly extend previous studies by prospectively examining a larger population that was strictly restricted to a younger cohort that may be considered most likely to be influenced by having a positive FH.