Cardiovascular risk factors weaken coronary artery plaques

In the event of a myocardial infarction, currently referred to as Acute Coronary Syndrome (ACS), the degree of obstruction of the coronary artery in question is a very important factor in the occurrence of the accident: The more the artery is narrowed by atherosclerotic plaque, known as stenosis, the greater the risk of complete obstruction.
However, the element that triggers the acute event is the plaque and its interaction with its environment.
In all cases, atherosclerosis is the pathological process, but plaque can worsen in two ways: the classic brutal rupture, and the erosion of the innermost part of the artery: the endothelium in direct contact with the blood. As a result, some plaques are more likely to become complicated than others. We now know which characteristics are more associated with the risk of rupture or erosion.
In women, because coronary disease is different and affects small vessels, there are more erosions than ruptures, which could explain a different symptomatology at the onset of an infarction.
Epidemiology has made it possible to identify the main risk factors (FDR) associated with cardiovascular events, but the relationship between the number of FDR and the fragility or "vulnerability" of the plaque had never been systematically studied before the study presented in this article.
Fragility assessment
A team of researchers assessed the association between the number of cardiovascular risk factors and atherosclerotic plaque fragility. They studied the plaques using a specific examination known as optical coherence tomography (OCT), a type of CT scanner.
This device enables the structure of plaques to be visualized, but is not widely used in everyday practice.
Patients who had suffered an infarction were divided into 5 groups according to the number of usual DRFs: arterial hypertension, hyperlipidemia, diabetes, smoking, then classified into 2 groups according to whether the number of DRFs was 0, 1 or greater than or equal to 2.
Of the 2,187 plaques analysed, 1,581 were responsible for the infarction and 606 were not, since in the same person the 2 types can exist simultaneously.
Among the plaques responsible for the event, certain markers of plaque fragility were more frequent as the number of FDRs increased: lipid-rich plaques with cholesterol crystals, a thinner fibrous envelope and the presence of micro-vessels within the plaque. These could be described as "soft", recent plaques in which the calcification process that stabilizes them has not yet occurred.
The presence of at least two FDRs was associated with all fragility criteria, with the exception of lipid-rich plaques. Plaque rupture was more frequent as the number of FDRs increased, unlike erosion.
It should be emphasized that the usual screening tests, such as the coronary calcium score which, as its name suggests, is based on the visualization and counting of calcifications, are unable to detect this type of anomaly. Coronary CT scans, with a moderate dose of contrast media injected, now enable vulnerable plaques to be identified and studied in detail using the latest equipment. Multicenter studies are currently underway to validate the preventive prescription of a coronary CT scan in asymptomatic non-diabetic subjects with multiple FDRs.

In conclusion,
In patients presenting with myocardial infarction, and this is very consistent, a higher number of cardiovascular FDRs is very clearly linked to more fragile plaques at the origin of this infarction.
What's more, the presence of these risk factors at the time of the accident means a poorer prognosis.
This is why it is so important to intervene as early as possible, by identifying the risk factors and managing them through lifestyle modification and dedicated pharmacological treatment (in particular statins, antihypertensive treatment, etc.). It should be stressed once again that even small, non-stenosing plaques, described as "not very threatening", are in fact fragile and expose the patient to avoidable acute complications.
Act rather than suffer by screening, treating and being monitored very regularly by your GP and specialist.
Reference:

Covani M. et al: Plaque vulnerability and cardiovascular rissk factoor burden in acute coronary syndrome: An optical coherence tomography analysis.
JACCl (2025) ;(86)2 :77-89