Cardiometabolic phenotypes and imaging markers of coronary plaque instability: A multimodal analysis

Abstract

The present study provides a comprehensive assessment of the association between cardiovascular imaging signatures of coronary atherosclerosis progression and the cardiometabolic phenotype, specifically focusing on metabolic and behavioral risk factors in patients with coronary artery disease (CAD). Using data obtained from multislice computed tomography coronary angiography (MSCT-CA), including the Agatston coronary artery calcium score, a correlation analysis was performed with dysmetabolic and behavioral cardiovascular risk factors such as obesity, dyslipidemia (LDL-C and HDL-C levels), arterial hypertension, smoking, physical inactivity, and psychoemotional stress depending on the clinical course of CAD. The study demonstrated that the strength of the association between coronary artery calcium and cardiovascular risk factors was determined by the clinical phenotype of CAD. In stable CAD, the strongest correlations were observed with age, arterial hypertension, and dyslipidemia, whereas no significant differences were identified regarding the relationship between calcium score, smoking, and obesity between stable and unstable angina groups. Correlations between coronary calcium burden, physical inactivity, and psychological stress remained weak regardless of the clinical course of the disease. These findings demonstrate the differentiated impact of cardiovascular risk factors on various aspects of atherosclerotic progression and may contribute to the development of more precise risk stratification strategies and individualized prognostic assessment in patients with CAD.