High-Risk Coronary Plaque and Carotid Findings in Asymptomatic Adults Undergoing Primary Cardiovascular Prevention

High-risk coronary plaque was present in 30.9% of these asymptomatic adults. Obstructive coronary artery disease with ≥50% stenosis was detected in 28.0%.

HRP was found in 26.6% of participants with non-obstructive coronary disease and in 64.6% of those with obstructive disease.

The prevalence of HRP increased across the combined carotid ultrasound and CAC categories:

10.0% — no carotid plaque + CAC <100; 27.7% — mild carotid atherosclerosis + CAC <100; 41.2% — no carotid plaque + CAC ≥100; 59.4% — mild carotid atherosclerosis + CAC ≥100

Among participants with mild carotid atherosclerosis, current smoking was the only independent clinical correlate of high-risk coronary plaque (OR 2.1; 95% CI 1.0–4.5; p=0.049).

Coronary atherosclerosis can be present before symptoms develop. This study found high-risk coronary plaque in almost one-third of a selected group of asymptomatic adults undergoing primary cardiovascular prevention assessment.

The results also show the value of looking at atherosclerosis across different vascular territories. Carotid ultrasound provides information about carotid atherosclerosis, while CAC scoring measures calcified coronary plaque burden. CCTA provides a more detailed anatomical assessment of the coronary arteries, including plaque morphology and coronary stenosis.

For cardiovascular longevity, identifying subclinical atherosclerosis in selected higher-risk individuals may allow cardiovascular risk to be assessed earlier and preventive management to be more closely matched to the presence and extent of disease.

The study involved asymptomatic adults at high cardiovascular risk, not an unselected general population. Its findings should therefore not be interpreted as evidence for routine CCTA screening of all asymptomatic adults.

The results are particularly relevant to primary prevention because they show that the absence of symptoms does not exclude substantial coronary atherosclerosis. Both obstructive disease and high-risk plaque were found in this selected population.

Carotid ultrasound, CAC scoring and CCTA provide complementary information. A carotid plaque documents atherosclerosis in another vascular territory; CAC quantifies calcified coronary atherosclerosis; CCTA can additionally identify non-calcified and mixed plaque, characterize plaque morphology and assess coronary stenosis.

The combination of mild carotid atherosclerosis and CAC ≥100 was associated with the highest prevalence of HRP. This suggests that integrating vascular and coronary imaging findings may provide information beyond traditional cardiovascular risk factors when assessing selected high-risk individuals.

CCTA findings must still be interpreted within the complete clinical context. Detection of coronary stenosis does not automatically indicate invasive coronary angiography or revascularization; further assessment may include functional testing or specialist cardiology evaluation depending on the anatomy and clinical situation.

The study was retrospective, relatively small (269 participants) and based on a cardiovascular high-risk cohort, which limits generalizability. It evaluated imaging findings rather than subsequent cardiovascular events and therefore cannot establish that this imaging strategy reduces myocardial infarction or cardiovascular mortality.

The authors concluded that combining carotid ultrasound, coronary calcium scoring and CCTA may improve primary-prevention risk stratification beyond traditional cardiovascular risk factors.