The cardiovascular risk factors associated with the plaque pattern on coronary computed tomographic angiography in subjects for health check-up

BACKGROUND Although it is known that coronary computed tomographic angiography (CCTA) offers highly negative predictive value to exclude obstructive coronary lesions, the plaque pattern on CCTA has not been fully understood. The purpose of this study was to explore the difference of the plaque patterns on CCTA and to assess the cardiovascular risks in healthy subjects. METHODS A total of 3914 subjects (mean age: 55 ± 10 years, M : F = 2649 : 1265) who underwent CCTA for health check-up between January 2009 and December 2012 were enrolled. According to coronary artery calcium score (CACS) and plaque pattern on CCTA, subjects were categorized into four groups (group 1: normal; group 2: "non-calcified" plaque; group 3: "calcified" plaque; group 4: mixed plaque). We analyzed cardiovascular risks and Framingham risk score (FRS) among the groups. RESULTS The incidence of each group was group 1 in 55.0% (2152/3914), group 2 in 5.1% (200/3914), group 3 in 8.2% (319/3914), and group 4 in 7.2% (280/3914), respectively. There was no difference of FRS among the groups (6.4 ± 6.4%; 6.5 ± 4.6%; 8.2 ± 5.8%; 7.7 ± 5.7% p = 0.086). In multivariate analysis, HbA1c (OR = 2.285; 95%CI = 1.029 - 5.071; p = 0.042) in group 2; age (OR = 1.115; 95%CI = 1.034 - 1.202; p = 0.005) and smoking status (OR = 3.386; 95%CI = 1.124 - 10.202; p = 0.030) in group 3; and age (OR = 1.054; 95%CI = 1.011 - 1.099; p = 0.014) and hypertension (OR = 3.087; 95%CI = 1.536 - 6.202; p = 0.001) in group 4 were independent factors. CONCLUSIONS Our data suggest that more individualized therapy for reduction of cardiovascular risks associated with plaque pattern on CCTA could be considered in healthy subjects.