Cardiovascular risk factors are associated with an increased risk of heart disease, but it is unclear how they relate to sudden closure of coronary arteries, which can lead to heart attack or sudden cardiac death. A new study by researchers at the Massachusetts General Brigham Heart and Vascular Institute found that people with a higher burden of modifiable risk factors, such as high blood pressure, high cholesterol, diabetes, smoking, and obesity, had a more widespread buildup of plaque in their major coronary arteries. Furthermore, these modifiable factors were associated with more unstable and high-risk plaques that are more likely to rupture and cause heart attacks. Results are posted below JACC: Progress.
The more vulnerable plaques, or plaques that are susceptible to rupture, the more likely one of them will cause an adverse event. Our findings highlight the importance of early, intensive, and sustained intervention to control modifiable risk factors and prevent future events. ”
Ik-Kyung Jang, MD, PhD, senior author, Brigham Heart and Vascular Institute
To better understand how modifiable and nonmodifiable risk factors (such as age, gender, and family history of heart disease) influence dangerous plaque buildup, the research team examined plaque burden and plaque characteristics in all three major coronary arteries. They analyzed 534 plaques from 131 patients who underwent optical coherence tomography (OCT), an intravascular imaging technique that allows plaques to be visualized in high resolution.
The researchers reported that patients with more risk factors had more plaque in all three coronary arteries. Additionally, a higher number of modifiable risk factors was associated with fewer stable plaques and a greater prevalence of vulnerable plaque characteristics, such as lipid plaques with thin fibrous caps that are susceptible to disruption. In contrast, non-modifiable risk factors were associated with a more stable plaque phenotype.
The authors note that prospective studies with larger cohorts, including patients previously treated for coronary artery occlusion, are needed to generalize the findings.
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Reference magazines:
Chmiel, J. Others. (2026) Associations between cardiovascular risk factors and pan-coronary plaque burden, phenotype, and vulnerability: 3 vascular imaging studies. Jack: Progress. DOI: 10.1016/j.jacadv.2026.102983. https://www.jacc.org/doi/10.1016/j.jacadv.2026.102983
