Key result
Early CAD is linked to ~5.6-fold higher global plaque burden on 3DVUS, driven by femoral disease.
Why the study?
Early coronary artery disease events are increasing and sometimes occur in individuals with minimal atherosclerosis, suggesting heterogeneous underlying mechanisms. Carotid and femoral plaque burden in these patients, its relationship to underlying risk phenotypes, and how it compares with an asymptomatic reference cohort had not been previously reported.
Does 3-dimensional vascular ultrasound quantification of carotid and femoral plaque burden identify distinct risk factor phenotypes in patients with early coronary artery disease events compared to an asymptomatic reference cohort?
Cohort (n=231)
No
Does 3-dimensional vascular ultrasound quantification of carotid and femoral plaque burden identify distinct risk factor phenotypes in patients with early coronary artery disease events compared to an asymptomatic reference cohort?
Quantifying carotid and femoral plaque burden via 3D vascular ultrasound in patients with early coronary artery disease reveals distinct pathophysiological phenotypes—differentiating those driven by conventional risk factors with high plaque burden from those with minimal plaque and non-conventional risk factors—to guide individualized prevention.
Answers are grounded in this paper and cite their sources.
Femoral plaque exceeds carotid in early CAD; hypothesis-generating for territory-specific 3D ultrasound in risk phenotyping.
BACKGROUND: Early coronary artery disease events (eCAD) are increasing, occasionally occurring in individuals with minimal atherosclerosis, suggesting heterogeneous underlying mechanisms. We report, for the first time, carotid and femoral plaque burden in eCAD patients, relate it to underlying phenotypes, and compare it with the PESA reference cohort to explore preventive implications. METHODS: eCAD patients (<60 years) were consecutively and prospectively enrolled at a tertiary hospital. Conventional and non-conventional cardiovascular risk factors (CVRF) and blood biomarkers were assessed, and global atherosclerosis plaque burden (GPB) was quantified as total carotid and femoral plaque volume by 3-dimensional vascular ultrasound (3DVUS). RESULTS: Among 231 eCAD patients (53 ± 5 years old; 14% women; 23% with a prior event; 52% presented with STEMI) conventional CVRF were frequent but prevalence of non-conventional CVRF was high (28% elevated lipoprotein a, 25% family history of premature CVD, 25% hyperuricemia, and 14% hyperhomocysteinemia). Underlying GPB was high (268.7 mm3 [IQR75.2-509.9]), being higher in the femoral than the carotid territory (200.6 mm3 [IQR51.7-420.7] vs 35.2 mm3 [IQR7.9-96.2], p < 0.001), and increased with age. Compared with age-matched asymptomatic individuals (PESA study), eCAD patients had markedly higher GPB (284.1 mm3 [IQR110-546.8] vs 50.8 mm3 [18.7-121.5]). However, GPB in eCAD patients varied widely. Severe GBP (percentile≥75th) identified a subgroup with predominantly conventional CVRF and prior CVD, with marginal presence of non-conventional factors, compared with those with no-or-mild GPB (percentile≤25th). CONCLUSION: Carotid and femoral PB by 3DVUS identifies distinct pathophysiological phenotypes in eCAD, underscoring the value of atherosclerosis assessment for individualized management and prevention.
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López‐Melgar et al. (2026) conducted a cohort in Early coronary artery disease events (eCAD) (n=231). 3-dimensional vascular ultrasound (3DVUS) assessment of carotid and femoral plaque burden in eCAD vs. Age-matched asymptomatic individuals (PESA reference cohort) was evaluated on Global atherosclerosis plaque burden (GPB) quantified as total carotid and femoral plaque volume. Patients with early CAD had markedly higher global plaque burden on 3DVUS than age-matched PESA controls, driven by femoral over carotid plaque.
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