Int J Cardiol. 2026 Oct 31:135023. doi: 10.1016/j.ijcard.2026.135023. Online ahead of print.
ABSTRACT
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.
PMID:42966510 | DOI:10.1016/j.ijcard.2026.135023