Carotid and femoral plaque burden in patients with early coronary artery disease events: Prevalence, extent and relationship to risk phenotypes.

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 eCAD, 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 CAD, 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.