Hidden Cardiovascular Phenotypes in Apparently Low risk Cardiology Outpatients

Background: Patients classified as low risk in routine cardiology outpatient practice are generally assumed to have minimal cardiovascular vulnerability. However, conventional risk assessment focuses primarily on overt clinical events and may overlook early biological, electrical, functional, and structural abnormalities. Whether a limited set of clinically key associated factors an explain subclinical cardiovascular vulnerability in apparently low-risk outpatients remains unclear.Methods: This retrospective observational study included 476 adults aged 18–75 years evaluated in a cardiology outpatient clinic. Patients with established cardiovascular disease or major cardiac comorbidities were excluded. Routine outpatient data encompassing clinical characteristics, laboratory findings, electrocardiography, exercise treadmill testing, and transthoracic echocardiography were reviewed. Subclinical cardiovascular vulnerability was defined as the presence of at least one abnormality across inflammatory, electrical, functional, or structural domains. Multivariable modeling was performed with emphasis on identifying clinically dominant determinants of subclinical cardiovascular phenotypes.Results: Subclinical cardiovascular vulnerability was identified in 30.0% of patients. Although multiple clinical, biochemical, and functional parameters were associated with this phenotype, the majority of the clinically relevant signal was driven by a limited subset of variables. Current smoking, ischemic ST-segment depression during exercise testing, and elevated hs-CRP consistently demonstrated the strongest associations, while other factors contributed more modestly to the overall risk profile.Conclusion: A substantial proportion of cardiology outpatients categorized as low risk exhibit subclinical cardiovascular vulnerability detectable through routine outpatient assessment. While several factors are associated with this phenotype, a small number of key associated factors appear to account for most of the clinically actionable risk. A focused, phenotype-oriented interpretation of simple outpatient markers may improve risk refinement and help identify individuals who warrant closer cardiovascular surveillance despite apparently low estimated risk.