Computed Tomography in the Evaluation and Identification of Features of Coronary Atherosclerosis Between European and Asian Populations in Kazakhstan

<i>Background and Objectives</i>: This study aimed to compare coronary plaque characteristics between Asian and European populations undergoing coronary CT angiography and to examine associations between cardiovascular risk factors and coronary artery calcification. <i>Materials and Methods</i>: In this retrospective, two-center, cross-sectional observational study, 1591 adult patients (1203 of Asian and 388 of European descent) referred for coronary computed tomography angiography (CCTA) due to suspected coronary artery disease between 2008 and 2025 were included. Demographic, clinical characteristics, and laboratory data were obtained from medical records. Computed tomography (CT) was performed on different CT scanners, including a 64-slice Siemens SOMATOM Definition AS, a 250-slice Siemens SOMATOM, a 640-slice multi-detector Canon Aquilion ONE, and a 128-slice multi-detector GE Revolution scanner with prospective cardiac synchronization and 0.6 mm slice reconstruction. Coronary artery calcium (CAC) scores were quantified using automated software "Vitrea". Associations between ethnicity, cardiovascular risk factors, and CAC were assessed using non-parametric analyses and multivariable regression models. Stata 18 software was used for all statistical analyses. <i>Results</i>: European participants demonstrated a higher prevalence of obesity, hypertension, tobacco use, and alcohol consumption compared with Asian participants. The prevalence of CAC > 0 was higher in Europeans than in Asians (60.6% vs. 50.3%, <i>p</i> < 0.01). European individuals were independently associated with CAC presence in multivariable analysis. Multivessel (≥2-vessel) stenosis and calcified plaques were more frequently observed in Europeans, whereas non-calcified and low-density plaques predominated among Asians. <i>Conclusions</i>: Within this referral-based cohort, differences in coronary plaque characteristics were observed between the studied groups within this clinical CCTA cohort. The European group was associated with a higher prevalence of calcified plaques, whereas non-calcified and low-density plaques were more frequently observed among Asian participants. These findings show associations between ethnicity and plaque characteristics within a clinical cohort and require confirmation in prospective studies.