CVD Risk Factor Burden and Plaque Progression on Coronary CT

Quick Takes

  • Coronary artery plaque progression was observed in all risk groups.
  • Plaque progression was greatest in high-risk patients.
  • High-risk patients were more likely to develop adverse plaque characteristics.

Study Questions:

What is the relationship between cardiovascular risk factors and coronary artery plaque progression on coronary computed tomography angiography (CCTA)?


This is a subgroup analysis of the observational PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) study, which examined the relationship between serial CCTA results and clinical presentation. This analysis examined patients without known coronary artery disease. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk score was assessed at the time of the index CT. Plaque volumes, percent atheroma volume, and adverse plaque characteristics were evaluated on CT, and the association between ASCVD risk (low <7.5%, intermediate 7.5-20.0%, or high >20.0%) and plaque changes was examined.


A total of 1,005 subjects were included in the analysis (mean age 60 ± 8 years, 57.2% men). The median time between the studies was 3.3 years (interquartile range, 2.6-4.8 years). Low, intermediate, and high ASCVD risk scores were observed in 46%, 37%, and 17%, respectively. The annualized percent atheroma volume was higher in the high-risk group compared to the intermediate- and low-risk groups for total plaque (0.99% vs. 0.58% vs. 0.45%, respectively; p < 0.001), with a similar pattern observed for calcified plaque (p < 0.001) and noncalcified plaque (p = 0.01). Development of adverse plaque characteristics between the serial scans was greater in the high-risk group compared to the intermediate- and low-risk groups (43.2% vs. 35.7% vs. 32.6%, respectively, p = 0.02).


Coronary artery atherosclerosis progresses across all risk groups, but patients with a higher ASCVD risk score experience greater rates of plaque progression, and are more likely to develop adverse plaque characteristics over time.


This study represents the largest serial CCTA study at present and observes that increased ASCVD risk is associated with greater progression of coronary artery plaque burden. Adverse plaque characteristics, which have been reported to be associated with increased risk of cardiovascular events, were more frequently observed on baseline imaging in higher-risk patients, while these patients were also more likely to develop adverse plaque characteristics over time. Interval development of individual adverse plaque characteristics was not significantly different between low- and intermediate-risk groups, suggesting that ASCVD risk may not adequately differentiate these cohorts. The potential effects of statins and other medication usage between serial studies could not be reliably examined, which represents a significant limitation of this study. Future studies are needed to evaluate the effects of treatment on coronary plaque changes and related outcomes.

Clinical Topics: Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Nonstatins, Novel Agents, Statins, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Computed Tomography, Nuclear Imaging

Keywords: Angiography, Atherosclerosis, Coronary Angiography, Coronary Artery Disease, Diagnostic Imaging, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Plaque, Atherosclerotic, Risk Factors, Secondary Prevention, Tomography, X-Ray Computed

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