Plasma fatty acid profiles and coronary artery disease burden assessed by coronary CT angiography: an observational study

Atherosclerotic coronary artery disease (CAD) remains a leading cause of death globally, and individual susceptibility is not fully explained by standard risk factors. The role of plasma fatty acid profiles in relation to imaging-defined CAD burden remains less well established. We performed a cross-sectional cohort analysis of 1,002 participants undergoing coronary computed tomographic angiography (CCTA), with blood samples collected immediately prior to contrast administration. Plasma fatty acids were quantified as a percentage of total plasma fatty acids and evaluated for associations with CAD burden, including coronary artery calcium score (CACS), CACS percentile, Gensini score, soft plaque score, and atrial fibrillation (AF). Associations were assessed using multivariate logistic regression, adjusting for age, sex, and cardiovascular risk factors. Higher plasma omega-6 levels were inversely associated with CACS (CAC+; odds ratio OR = 0.93, 95% confidence interval CI = 0.90–0.97) with similar inverse associations observed for Gensini and soft plaque scores. In contrast, monounsaturated (CAC + OR = 1.09, 95% CI = 1.03–1.15) and saturated fatty acids (CAC + OR = 1.08, 95% CI = 1.04–1.12) were positively associated with CAD burden. No consistent associations were observed with self-reported atrial fibrillation after multivariable adjustment. Plasma omega-6 fatty acids demonstrated inverse associations with imaging-defined CAD burden, suggesting a potential protective role that warrants investigation in longitudinal studies. Saturated and monounsaturated fatty acids were positively associated with CAD, aligning with prior evidence of their atherogenic potential.