Coronary Plaque Burden in South Asian Adults

BACKGROUND: South Asian (SA) adults have disproportionately high rates of premature coronary artery disease, yet conventional risk calculators may not fully capture coronary plaque burden. OBJECTIVES: We analyzed the DILWALE (DIL Wellness and Arterial Health Longitudinal Evaluation) registry to quantify coronary plaque burden using computed tomography angiography (CTA) and compare it across risk categories using the 10-year atherosclerotic cardiovascular disease (ASCVD) risk calculator and American Heart Association PREVENT-ASCVD Calculator. METHODS: The DILWALE study is a medical record-based multicenter registry of SA adults (≥18 years) within Baylor Scott & White Health system. Patients who underwent clinically indicated coronary CTA were included and were risk stratified based on the PREVENT-ASCVD and Pooled Cohort Equations (PCE) risk scores. Quantitative plaque analysis was done using HeartFlow's plaque analysis tool to evaluate the association among PCE, PREVENT, and plaque burden. RESULTS: in the borderline-, intermediate-, and high-risk groups, respectively (P < 0.0001). CONCLUSIONS: In this SA cohort, higher PREVENT and ASCVD/PCE risk categories were associated with higher plaque burden. CTA reveals substantial noncalcified plaque missed by calcium scoring, underscoring its value for anatomic risk in SA adults.