Association of cardiovascular risk scores with coronary plaque and its progression among individuals with family history of coronary artery disease.

Background: Multiple cardiovascular (CV) risk assessment scores can predict CV events. The current trend towards assessing atheroma has led to these scores being used to identify patients who might benefit from coronary plaque imaging. However, their association with plaque burden and progression is unclear. This study aimed to evaluate the relationship between CV risk scores, coronary plaque burden and its evolution. Methods: Asymptomatic, intermediate-risk individuals aged 40-70 years with a family history of CAD and not on statin therapy were recruited from 7 hospitals across Australia and multiple baseline CV risk scores were calculated. Participants with coronary artery calcium score (CACS) between 1-400 underwent coronary angiography, which was repeated 3 years post-baseline. Results: Of 1,060 participants (mean age 56±7 years, 54% female) who underwent CACS, 499 (44%) had CACS>0. Subsequently, 365 completed baseline and follow-up coronary angiography. The PREDICT 5-year risk score had the strongest, albeit weak, correlation (R Conclusion: At best, there were only weak associations between conventional risk scores and plaque burden, and plaque progression. These findings highlight the limitations of current risk tools for predicting plaque burden and the need for a new screening approach, whether universal CACS screening or integration of emerging biomarkers, to better identify individuals who would benefit from early preventive interventions.