Non-Conventional Risk Factors in Acute Coronary Syndrome

Background: Acute coronary syndrome (ACS) remains a major cause of morbidity and mortality. Beyond conventional risk factors, non-conventional lifestyle and psychosocial exposures may contribute to adverse coronary and vascular phenotypes. Objective: To evaluate the association of selected non-conventional exposures with ACS and to examine their relationships with structural vascular/adipose imaging markers. Methods: We conducted a case–control study including 300 participants (150 ACS cases and 150 controls without ACS confirmed by coronary angiography or coronary CT angiography) at the University Hospital Center “Mother Teresa”, Tirana (2024–2025). Physical activity, sleep duration, dietary pattern, alcohol use, and psychosocial factors were compared between groups, alongside epicardial adipose tissue (EAT), pericardial adipose tissue (PAT), and carotid intima–media thickness (CIMT; right and left). Results: Cases were older than controls (66.1 ± 10.7 vs 57.4 ± 10.9 years) and more frequently male (74.7% vs 66.0%). Physical inactivity, short sleep duration, high-fat dietary patterns, and higher alcohol intake were more common among cases (all p < 0.001), whereas Mediterranean diet adherence was markedly lower. EAT and CIMT (right and left) were significantly higher in cases than controls (all p < 0.001), and PAT was also higher among cases (p = 0.004). Conclusions: In this Albanian cohort, ACS was strongly associated with modifiable non-conventional exposures—particularly short sleep, low physical activity, and unhealthy diet—and with adverse vascular/adipose imaging phenotypes. These findings support integrating key lifestyle and psychosocial factors alongside structural markers in regional cardiovascular risk profiling.