Cardiovascular risk factors are linked to higher risk of heart disease, but it has been unknown how they are related to abrupt closure of the coronary arteries leading to heart attack and sudden cardiac death. A new study by Mass General Brigham Heart and Vascular Institute investigators finds that people with higher modifiable risk factors burden such as high blood pressure, high cholesterol, diabetes, smoking and obesity have more widespread buildup of plaques in major coronary arteries. Furthermore, these modifiable factors were associated with more unstable, high-risk plaques that are prone to rupture and cause heart attacks. Results are published in JACC: Advances .
"The higher the number of vulnerable, or rupture-prone plaques, the greater the chance that one of them will trigger an adverse event," said senior author Ik-Kyung Jang, MD, PhD, at the Mass General Brigham Heart and Vascular Institute. "Our findings highlight the importance of early, intensive and sustained interventions to control the modifiable risk factors and prevent future events."
To better understand how modifiable risk factors and non-modifiable risk factors (including age, sex and family history of heart disease) influence dangerous plaque buildup, the research team examined plaque burden and plaque characteristics across all three major coronary arteries. They analyzed 534 plaques in 131 patients who underwent optical coherence tomography (OCT), an intravascular imaging modality that can visualize plaques at high resolution.
The researchers reported that patients with more risk factors had more plaques across all three coronary arteries. In addition, greater number of modifiable risk factors was associated with fewer stable plaques and more prevalent vulnerable plaque features such as lipid plaques with thin fibrous caps that are susceptible to disruption. In contrast, non-modifiable risk factors were associated with more stable plaque phenotypes.
The authors note that prospective research involving larger cohorts, including patients who have previously been treated for blocked coronary arteries, is needed to generalize their findings.
Authorship: In addition to Jang, Mass General Brigham authors include Jakub Chmiel, Stefano Andreaggi, Sekeun Kim, Iris McNulty, and Hang Lee. Additional authors include Adrian Banning, Krzysztof L Bryniarski, and Piotr Musialek.
Funding: Musialek received a grant from the National Science Centre, Krakow, Poland (UMO 2020/39/O/NZ5/0286). Dr. Jang's research has been supported by the Allan and Gill Gray Foundation and Mukesh and Priti Chatter through the Chatter Foundation. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication. The remaining authors have nothing to disclose.
Paper cited: Chmiel J., et al. "Association Between Cardiovascular Risk Factors and Pan-Coronary Plaque Burden, Phenotype, and Vulnerability: 3-Vessel Imaging Study" JACC: Advances DOI: 10.1016/j.jacadv.2026.102983
