Non-modifiable cardiovascular risk factors and coronary plaque characteristics in patients with acute coronary syndromes

Aims: Cardiovascular risk factors predict adverse clinical outcomes, including acute coronary syndromes (ACS). A recent study showed a close correlation between the number of modifiable risk factors and plaque vulnerability. However, the relationship between non-modifiable risk factors (NMRFs) and plaque characteristics has been unexplored. This study aimed to correlate the number of NMRFs with coronary plaque characteristics defined by optical coherence tomography (OCT). Methods and results: Patients with ACS were divided into four groups based on the number of NMRFs (age ≥70 years, male sex, and family history of coronary artery disease). Lesion characteristics in both culprit and non-culprit plaques were analysed. A total of 2345 plaques (1663 culprit and 682 non-culprit plaques) were analysed. In culprit plaques, the prevalence of both OCT-defined vulnerable features and plaque rupture did not increase as the number of NMRFs increased (P-trend > 0.05 for each vulnerable feature and P-trend for plaque rupture: 0.856). In non-culprit plaques, no association between the number of NMRFs and vulnerable features was observed. However, the number of NMRF was directly correlated with calcified plaque (OR 2.60, 95% CI 2.01–3.37, P < 0.001) and inversely correlated with erosion (OR 0.72, 95% CI 0.61–0.84, P < 0.001). Conclusion: In patients with ACS, the burden of NMRFs was not correlated with OCT-defined plaque vulnerability or the prevalence of plaque rupture, both at culprit and non-culprit lesions. Conversely, a higher number of NMRF was linked to a greater probability of calcified plaque and a lower probability of plaque erosion. Clinical Trial Registration: Clinicaltrials.gov NCT01110538, NCT03479723, NCT04523194. https://www.umin.ac.jp/ctr/, UMIN000047254.