Association between gallstones and subclinical coronary atherosclerosis: An observational study with propensity score matching

Previous studies reporting an association between gallstones and coronary artery disease have not considered the types of coronary artery plaque. Additionally, the association between gallstones and subclinical coronary atherosclerosis has not been clearly elucidated. Therefore, this study aimed to analyze the association between gallstones and subclinical coronary atherosclerosis based on the type of coronary artery plaque in asymptomatic Koreans using coronary computed tomography angiography. We retrospectively analyzed 9,113 individuals (mean age, 53.7 ± 8.0 years; 5,907 men [64.8%]) who had no history of coronary artery disease and underwent a general medical checkup. Gallstones were diagnosed by transabdominal ultrasonography. Coronary computed tomographic angiography was used to evaluate the type of coronary artery plaque and the severity of subclinical coronary atherosclerosis, and a diameter stenosis of ≥50% was considered clinically significant. Logistic regression and propensity score matching analyses were performed to determine the association between gallstones and subclinical coronary atherosclerosis. Among the study participants, 503 (5.5%) had gallstones. After adjusting for risk factors, significant associations were found between gallstones and noncalcified plaque (adjusted odds ratio [OR], 1.728; 95% confidence interval [CI] 1.267-2.357; p = 0.001), as well as between gallstones and significant coronary artery stenosis (adjusted OR, 1.386; 95% CI, 1.002-1.917; p = 0.049). In asymptomatic individuals, gallstones were independently associated with noncalcified plaque (the high-risk plaque) and significant coronary artery stenosis which is often linked to poorer cardiac outcomes. It is crucial to acknowledge the potential for subclinical coronary atherosclerosis and to effectively manage cardiovascular risk factors in individuals with gallstones.