Association Between Cardiovascular Risk Factors and Pan-Coronary Plaque Burden, Phenotype, and Vulnerability

Figure 1. Number of Plaques and Plaque Phenotypes Across Increasing Risk Factor Burden Mean number of plaques and each plaque phenotype across increasing numbers of (A) all cardiovascular risk factors, (B) modifiable risk factors, and (C) non-modifiable risk factors. As the number of cardiovascular risk factors increased, the total number of plaques, including high-risk thin-cap fibroatheromas, increased, whereas the number of stable fibrous plaques decreased. Although the increasing trend in the total number of plaques was observed with both modifiable and non-modifiable risk factors, higher numbers of high-risk thin-cap fibroatheromas were observed only with increasing numbers of modifiable risk factors. Trend lines are shown, and Jonckheere-Terpstra trend test P values are provided. TCFA = thin-cap fibroatheroma; ThCFA = thick-cap fibroatheroma.

Figure 2. Number of Vulnerable Features Across Increasing Cardiovascular Risk Factor Burden Mean number of vulnerable features and each vulnerable feature across increasing numbers of (A) all cardiovascular risk factors, (B) modifiable risk factors, and (C) non-modifiable risk factors. As the number of cardiovascular risk factors, both modifiable and non-modifiable, increased, the total number of vulnerable features increased, as did the number of lipid-rich plaques. However, an increase in the number of thin fibrous caps was observed only with increasing numbers of modifiable risk factors. Trend lines are shown, and Jonckheere-Terpstra trend test P values are provided. VF = vulnerable feature.

Central Illustration. Association Between Cardiovascular Risk Factor Burden and Pan-Coronary Vulnerability Among patients with coronary artery disease who underwent three-vessel optical coherence tomography (n = 131), pan-coronary vulnerability, as reflected by the patient-level prevalence of vulnerable plaque features including thin fibrous caps, lipid-rich plaques, macrophages, microvessels, and cholesterol crystals, increased in proportion to the number of cardiovascular risk factors (P trend <0.001). OCT = optical coherence tomography; PCI = percutaneous coronary intervention.

Figure 3. Associations of Risk Factor Burdens With Optical Coherence Tomography-Defined Plaque Characteristics Forest plot of multivariable associations of modifiable and non-modifiable cardiovascular risk factor burdens with (A) total plaque count and plaque counts by phenotype and (B) total vulnerable feature counts and individual vulnerable feature counts. An increasing number of non-modifiable risk factors was associated with higher numbers of plaques, particularly fibrocalcific plaques, whereas an increasing number of modifiable risk factors was associated with higher numbers of high-risk thin-cap fibroatheromas and thick-cap fibroatheromas, as well as fewer fibrous plaques. In contrast to non-modifiable risk factors, an increasing number of modifiable risk factors was associated with greater pan-coronary vulnerability, driven by higher numbers of all analyzed vulnerability features. Abbreviations as in Figures 1 and 2.