Abstract
Background
The AHA recommends statins in patients with CACS>100 AU. However in patients with
low CACS (1–99 AU), no clear statement is provided, leaving the clinician in a grey-zone.
High-risk plaque (HRP) criteria by coronary CTA are novel imaging biomarkers indicating
a higher a-priori cardiovascular (CV) risk, which could help for decision-making.
Therefore the objective of our study was to identify which CV-risk factors predict
HRP in patients with low CACS 1–99.
Methods
1003 symptomatic patients with low-to-intermediate risk, a clinical indication for
coronary computed tomography angiography (CCTA) and who had a coronary artery calcium
score (CACS) between 1 and 99 AU, were enrolled. CCTA analysis included: stenosis
severity and HRP-criteria: low-attenuation plaque (LAP <30HU, <60HU and <90HU) napkin-ring-sign,
spotty calcification and positive remodeling. Multivariate regression models were
created for predicting HRP-criteria by the major 5 cardiovascular risk factors (CVRF)
(smoking, arterial hypertension, positive family history, dyslipidemia, diabetes)
and obesity (BMI>25 kg/m2).
Results
304 (33.5%) were smokers. 20.4% of smokers had HRP compared with only 14.9% of non-smokers
(p = 0.045). Male gender was associated with HRP (p < 0.001).
Smoking but not the other 5 CVRF had the most associations with HRP-criteria (LAP<60HU/≥2
criteria:OR 1.59; 95%CI:1.07–2.35), LAP<90HU (OR 1.57; 95%CI:1.01–2.43), Napkin-Ring-Sign
(OR 1.78; 95%CI:1.02–3.1) and positive remodelling (OR 1.54; 95%CI:1.09–2.19). Smoking
predicted fibrofatty LAP<90HU in males only. Obesity predicted LAP<60HU in both females
and males.
Conclusions
In patients with low CACS 1-99AU, male gender, smoking and obesity, but not the other
CVRF predict HRP. These patients would rather benefit from intensification of primary
CV-prevention measures such as statins.
Keywords
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Article info
Publication history
Published online: April 23, 2021
Accepted:
April 17,
2021
Received in revised form:
April 12,
2021
Received:
November 23,
2020
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of Society of Cardiovascular Computed Tomography.
