Coronary Plaque Burden and Progression in Los Angeles Firefighters Versus Matched Controls: A Cohort Study

OBJECTIVES: To assess coronary plaque burden in Los Angeles Fire Department firefighters compared to matched control subjects. METHODS: 302 LAFD subjects matched 1:1 with control subjects. Coronary artery calcium imaging, coronary computed tomography angiography, and AI-assisted quantitative plaque analysis compared coronary plaque burden between groups. 62 underwent follow-up CCTA. RESULTS: The LAFD cohort had significantly higher total plaque volume (138 vs 84 mm³), non-calcified plaque volume (108 vs 73 mm³), percent atheroma volume (3.5% vs 2.3%), and prevalence of low-density plaque (31% vs 19%), all p ≤ 0.01. In the serial-CCTA subset, annualized progression of total plaque volume, calcified plaque, and percent atheroma volume was significantly higher than NATURE-CT. CONCLUSIONS: These findings reveal an elevated burden and accelerated progression of coronary plaque in LAFD firefighters, emphasizing the need for comprehensive cardiovascular risk assessment and prevention strategies.