Search Results (243)

The mitochondrial DNA copy number (mtDNA-CN) is considered an indirect indicator of the number of mitochondria and of mitochondrial dysfunction; its decrease may indirectly reflect mitochondrial DNA (mtDNA) alterations. A reduction in mtDNA-CN is associated with the development of cardiovascular diseases, including coronary artery disease (CAD). The study evaluates the association of relative blood mtDNA-CN with premature CAD (pCAD) and cardiometabolic factors among Mexican individuals from the GEA (Genetics of Atherosclerotic Disease) Mexican cohort. Relative blood mtDNA-CN was quantified by real-time PCR in 835 patients with pCAD and 896 control subjects (defined as a coronary artery calcium score of zero, assessed by computed tomography). Associations were evaluated using logistic regression (odds ratio [95% confidence interval]) adjusted for potential confounders. Compared with controls, patients with pCAD exhibited significantly lower relative blood mtDNA-CN (5.6 [3.5–9.8] vs. 9.1 [5.1–13.2]. p < 0.001). Similar results were observed in the sex-stratified analysis. Specifically, relative blood mtDNA-CN in women (6.2 [3.8–9.9]) and men (5.5 [3.4–9.7]) with pCAD was lower than that in women (9.5 [6.3–13.7]) and men (8.2 [5.5–12.5]) from the control group (p < 0.001). After adjusting for age, sex, body mass index, smoking status, LDL-cholesterol, type 2 diabetes mellitus, hypertension and physical activity, higher relative blood mtDNA-CN showed a negative association with pCAD (0.903 [0.881–0.927], p = 4.96 × 10⁻¹⁵). This association remained significant in men (0.894 [0.866–0.922], p = 2.90 × 10⁻¹²) and women (0.917 [0.876–0.960], p = 2.1 × 10⁻⁴). Among patients with pCAD, an inverse correlation was observed between relative blood mtDNA-CN and total abdominal fat (p = 0.001), visceral fat (p = 0.015), and subcutaneous fat (p = 0.004). Overall, our results show that reduced relative blood mtDNA-CN is associated with pCAD, which could be indicative of mitochondrial alterations. Furthermore, the inverse correlation between relative blood mtDNA-CN and total, visceral, and subcutaneous abdominal fat suggests a link between mitochondrial dysfunction and abdominal adiposity in patients with pCAD. These findings support that decreased relative blood mtDNA-CN may serve as a marker associated with the presence of pCAD and for adipose tissue alterations in Mexican women and men. Full article

Background/Objectives: The extent to which inhibin B, a marker of Sertoli cell function, is affected by cardiometabolic disturbances remains insufficiently understood. The aim of this study was to evaluate the relationships between serum inhibin B levels and the atherogenic index of plasma (AIP), triglyceride–glucose (TyG) index, HOMA-IR, METS-IR, and C-reactive protein (CRP) in adult men aged 40–65 years and to secondarily investigate a possible association with coronary artery calcium score (CACS). Methods: This cross-sectional study included 67 men aged 40–65 years referred for coronary computed tomography angiography, sampled in a balanced manner across coronary artery calcium score (CACS) categories. Serum inhibin B levels were measured by a commercial sandwich ELISA; AIP, TyG index, HOMA-IR, and METS-IR were calculated from fasting biochemical measurements. Associations between inhibin B and cardiometabolic parameters were assessed using Spearman correlation analyses and age-adjusted partial correlations. Significant associations were further examined using multivariable linear regression. Results: The mean serum inhibin B level was 224 ± 35 pg/mL. The TyG index (ρ = −0.308, p = 0.011) and BMI (ρ = −0.348, p = 0.004) showed significant negative correlations with inhibin B, and both associations persisted after age adjustment. No significant associations were found with HOMA-IR, METS-IR, AIP, CRP, or CACS. Although BMI and the TyG index were not significantly correlated with each other (ρ = −0.084, p = 0.564), both variables remained independently associated with inhibin B in the multivariable model (TyG: β = −0.283, p = 0.015; BMI: β = −0.313, p = 0.007). The model explained 18.0% of the variance in inhibin B (R² = 0.180). Conclusions: In adult men, serum inhibin B levels were independently and inversely associated with BMI and the TyG index, whereas no significant relationship was observed with other metabolic, inflammatory, atherogenic, or coronary calcification markers. These findings suggest that the relationship between inhibin B and cardiometabolic health is not generalizable across all cardiometabolic indices and may be specifically related to the metabolic profile represented by adiposity and the TyG index. Full article

Background: The absence of coronary artery calcium (CAC = 0) on computed tomography (CT) portends a low but not zero coronary risk. However, the frequency and prognostic significance of non-calcified plaques in CAC = 0 patients are incompletely defined, and non-coronary artery disease (CAD) causes of coronary risk have been proposed. We sought to define the ischemic burden, CAD status, and outcomes of CAC = 0 patients. Methods: The Intermountain electronic medical records were searched for CAC = 0 patients undergoing stress positron emission tomography (PET)/CT between January 2016 and July 2022. We defined definite PET abnormality as ischemic burden (IB) ≥ 10%. Patients were followed for angiographic findings, interventions, and major adverse cardiovascular events (MACE) over 3.1 ± 1.3 years. Results: Of 22,542 PET/CT studies in primary prevention patients, 5054 (22.4%) had CAC = 0. Of these, 59 (1.2%) had IB ≥ 10% on PET. Selective coronary angiography was performed within 90 days in 25 (42%) of IB ≥ 10% patients. Severe CAD was present in 11, but findings were not explained by CAD in 14. Revascularization was indicated in 10 (16.9%) of 59 with IB ≥ 10% vs. 0.04% of IB = 0% (p < 0.0001); 3-year outcomes also were lower with IB = 0%. Conclusions: In this large series of stress PET/CT study data, IB ≥ 10% in patients with CAC = 0 was rare. Most positive PET tests were not explained by obstructive CAD. While CAC does not perfectly predict an absence of coronary ischemia or obstructive CAD, it is a strong marker of prognosis. Here, we show that IB by PET supplements CAC score to importantly refine risk assessment. Full article

Background: Coronary artery calcium score (CACS) is a well-established marker of coronary atherosclerotic burden and cardiovascular risk. While its association with left ventricular dysfunction has been extensively investigated, the relationship between CACS and right ventricular (RV) function remains insufficiently explored. This study aimed to evaluate the association between CACS and echocardiographic RV function parameters and to explore the discriminatory ability of CACS for identifying patients meeting predefined echocardiographic thresholds of RV dysfunction in patients with suspected stable coronary artery disease (CAD). Methods: This retrospective observational study included 96 patients who underwent coronary computed tomography angiography and transthoracic echocardiography within a 3-month interval. CACS was calculated using the Agatston method. RV function was assessed using tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RV-FAC), and tissue Doppler-derived systolic velocity (S′). Correlation analyses, subgroup comparisons, multivariable linear regression, receiver operating characteristic (ROC) analyses, decision curve analysis (DCA), and calibration analyses were performed. Results: CACS demonstrated significant inverse correlations with TAPSE (r = −0.42, p < 0.001), RV-FAC (r = −0.36, p = 0.002), and S′ (r = −0.31, p = 0.006). Patients with higher CACS values exhibited progressively impaired RV systolic function. In multivariable regression analyses, higher CACS remained associated with lower TAPSE, RV-FAC, and S′ after adjustment for age, hypertension, and diabetes mellitus. Exploratory ROC analyses demonstrated moderate discriminatory performance, with AUC values ranging from 0.70 to 0.76. DCA suggested a potential net benefit across a range of threshold probabilities, while bootstrap calibration analysis demonstrated acceptable agreement between predicted and observed outcomes. Conclusions: In this retrospective single-center cohort, higher CACS values were associated with lower conventional echocardiographic measures of right ventricular systolic function. However, given the selected study population, relatively small sample size, limited clinical and instrumental characterization, potential residual confounding, and absence of external validation, these findings should be considered exploratory. The present data do not establish CACS as a clinical predictor of right ventricular dysfunction or support its use for clinical decision-making. Full article

Background: Perioperative cardiovascular complications remain a major concern in patients undergoing noncardiac surgery. Coronary computed tomography (CT)-based imaging, including coronary artery calcium (CAC) scoring, coronary CT angiography (CCTA), and CT-derived fractional flow reserve (CT-FFR), enables noninvasive assessment of coronary plaque burden, anatomic stenosis, and functional ischemia. However, the comparative prognostic value of these CT-based imaging markers for predicting perioperative major adverse cardiac events (MACE) has not been systematically evaluated. Methods: We performed a systematic review and meta-analysis of studies evaluating CT-based coronary imaging before noncardiac surgery. PubMed, Embase, and Cochrane CENTRAL were searched from inception through December 2025. Studies were included if they assessed CAC, CCTA, or CT-FFR and reported perioperative MACE. Risk of bias was independently assessed by two reviewers using the Quality In Prognosis Studies (QUIPS) tool. Pooled effect estimates were calculated using a random-effects model. The CT-FFR analysis was pre-specified as exploratory given the limited number of eligible studies. Results: A total of 13 studies including 10,100 patients undergoing noncardiac surgery were included in the systematic review, and 9 studies were eligible for quantitative meta-analysis. Obstructive coronary artery disease detected by CCTA was strongly associated with perioperative MACE (pooled odds ratio [OR] 7.18, 95% confidence interval [CI] 3.89–13.25). CAC burden was also significantly associated with perioperative cardiac risk (pooled OR 2.48, 95% CI 1.76–3.50). One study evaluating CT-FFR demonstrated a strong association between CT-FFR-defined ischemia and perioperative events (OR 10.77, 95% CI 4.64–25.02). These findings suggest that different CT-based imaging markers provide complementary prognostic information, with anatomic and functional assessment offering higher point estimates than plaque burden scoring. Conclusions: CT-based coronary imaging markers are significantly associated with perioperative MACE in patients undergoing noncardiac surgery. CAC burden and obstructive CAD detected on CCTA demonstrated consistent prognostic associations with perioperative cardiovascular events across multiple studies. CT-FFR showed a strong exploratory signal in a single eligible study, suggesting a potential additional role for functional ischemia assessment, although further validation in larger prospective cohorts is required. CT-based coronary imaging may therefore provide valuable complementary information for perioperative cardiovascular risk stratification. Full article

Objectives: Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease with increasing prevalence and mortality. High-resolution computed tomography (HRCT) is routinely performed in IPF assessment and can provide additional quantitative information. However, the prognostic utility of these HRCT-based parameters in IPF remains uncertain. This study aimed to investigate the prognostic value of quantitative HRCT findings in predicting mortality among patients with IPF. Methods: In this retrospective cohort study, 48 patients diagnosed with IPF between 2014 and 2024 were analyzed. Demographics, pulmonary function tests, HRCT findings, and quantitative measurements, including coronary artery calcium (CAC) score; densities of hepatic, paraspinal muscle, and lumbar vertebral bone mineral; and HRCT-derived fibrosis scores, were collected at baseline and after at least two years. The primary outcome was all-cause mortality. Results: The mean age was 66.8 ± 8.5 years; 77.1% were male. During a median follow-up of 63.3 months, 22 patients (45.8%) died, mainly from IPF-related causes (71.4%). Non-survivors had significantly higher HRCT fibrosis scores both at diagnosis (p = 0.006) and at two years (p = 0.002). Fibrosis scores increased significantly over time in non-survivors (p = 0.019). CAC scores rose in both groups, with a greater increase in non-survivors, but their independent prognostic value was limited after adjustment. Multivariable analysis identified male sex (hazard ratio [HR]: 5.46, p = 0.031) and second-year fibrosis score (HR: 1.10, p < 0.001) as independent predictors of mortality. Conclusions: HRCT-derived fibrosis burden is an independent predictor of mortality in IPF, alongside male sex. While other HRCT-based measures showed limited prognostic significance, longitudinal increases in CAC scores suggested potential cardiovascular implications. Full article

Background: Benidipine is a long-acting calcium channel blocker used for the treatment of hypertension and chronic coronary syndrome. Although it effectively lowers blood pressure (BP), the relationship between BP reduction and improvement in angina-related health status during benidipine therapy remains uncertain. This study evaluated changes in BP and patient-reported angina-related health status in a large real-world cohort. Methods: This prospective, multicenter, observational cohort study included 1659 patients with hypertension and/or chronic coronary syndrome who underwent baseline clinical assessment before initiation of benidipine therapy and were reassessed after 3 months. Changes in systolic and diastolic BP and Seattle Angina Questionnaire-7 (SAQ-7) scores were evaluated. Multivariable linear regression analyses were performed to identify predictors of BP reduction and symptomatic improvement. A propensity score-matched analysis according to coronary artery disease (CAD) status was conducted to further explore differences in treatment response. Results: The mean age was 62.2 ± 12.2 years, and 54.0% of participants were women. Systolic BP decreased by 13.8 mmHg and diastolic BP by 6.7 mmHg (both p < 0.001). Mean SAQ-7 score increased by 8.1 points (p < 0.001), exceeding the established threshold for clinically meaningful improvement. Baseline SAQ-7 score showed the strongest association with change in SAQ-7, whereas baseline systolic BP was the strongest predictor of BP reduction. The correlation between changes in systolic BP and SAQ-7 was weak (r = 0.058, p = 0.023). In the propensity score-matched cohort (n = 732), BP reduction was similar regardless of CAD status, whereas improvement in SAQ-7 was greater in patients without obstructive CAD. Conclusions: In this multicenter real-world cohort, benidipine therapy was associated with significant BP reduction and clinically meaningful improvement in angina-related health status over 3 months. Symptomatic improvement showed only a weak association with BP reduction. These findings should be interpreted within the limitations of an observational study and warrant confirmation in controlled comparative studies. Full article

Background/Objectives: A novel CT dynamic angiographic imaging (CT-DAI) analytic algorithm was evaluated against the clinical gold standard for fractional flow reserve (FFR) measurement in patients with coronary artery disease (CAD) characterized by diffuse dense calcification and previous stent implantation. Methods: This retrospective feasibility study included 24 coronary arteries in 16 patients (age 69.9 ± 8.9 years, 11 males) with CAD who underwent dynamic CT myocardial perfusion scanning using a dual-source CT scanner after intravenous infusion of adenosine triphosphate. The included patients had analyzable proximal and distal coronary artery segments adjacent to the stenosis in the myocardial perfusion images and had corresponding invasive catheter-based FFR measurements for that stenosis. An in-house software based on the CT-DAI algorithm was used to compute FFR using the coronary time-enhancement curves sampled across the stenosis from stress myocardial CT perfusion images. The CT-DAI derived FFR values were then compared to the corresponding catheter-based FFR values. A coronary stenosis was considered functionally significant for FFR values below 0.8. Results: The mean axial length and calcium score of the coronary stenoses were 47.9 mm and 1911.63 Agatston Units, respectively. Eight coronary arteries received stents from previous treatments. The CT-DAI derived FFR values (0.822 ± 0.143) showed an excellent linear correlation (R = 0.974) with and were indifferent from the invasive FFR values (0.826 ± 0.147, p = 0.537), resulting in 100% per-vessel and per-patient sensitivity and specificity for the detection of functionally significant coronary stenosis. Bland–Altman analysis revealed a minimal mean difference in FFR measurements (0.004) between the two modalities with the lower and upper limits of agreement at −0.061 and 0.069, respectively. Conclusions: The findings suggest that CT-DAI can derive FFR for the coronary arteries with heavy calcification and stents from dynamic myocardial CT perfusion images. Full article

Cardiovascular disease (CVD) remains the leading global cause of morbidity and mortality. While low-dose aspirin is well established for secondary prevention, its role in primary prevention is controversial because modest benefits in cardiovascular benefits must be balanced against increased bleeding risk, as highlighted by recent large trials. Current guidelines recommend restricting aspirin use to individuals at higher cardiovascular risk without elevated bleeding risk, yet significant heterogeneity persists in defining these thresholds. Evidence from randomized trials, guidelines, cohort and modeling analyses, and post hoc or observational subgroup studies suggests that selected patients with advanced subclinical atherosclerosis or specific high-risk markers may have a more favorable risk–benefit profile, although the certainty and directness of evidence vary across subgroups. This narrative review and pragmatic clinical guide presents an illustrative tiered framework based on clinical, imaging, and biomarker markers—such as coronary artery calcium score, carotid plaque score, and lipoprotein(a)—to support individualized discussion of preventive aspirin therapy. The framework is not a validated risk calculator or standalone treatment algorithm, and decisions should balance absolute cardiovascular risk, major bleeding risk, evidence certainty, and patient preferences. Full article

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a systemic metabolic disorder associated with an elevated risk of cardiovascular disease. Mac-2 binding protein glycosylation isomer (M2BPGi), a noninvasive serum biomarker of hepatic fibrosis, has also been linked to adverse metabolic and cardiovascular outcomes. However, the association between serum M2BPGi levels and subclinical coronary atherosclerosis in individuals with MASLD remains unclear. We investigated the association between serum M2BPGi levels and coronary artery calcium score (CACS), an established imaging marker of subclinical atherosclerosis, in individuals with MASLD. Methods: This retrospective cross-sectional study included 6514 adults with MASLD who underwent health screening examinations between 2020 and 2025. Participants were categorized into quartiles according to serum M2BPGi levels: Q1 (<0.48), Q2 (0.48–0.61), Q3 (0.62–0.80), and Q4 (≥0.81). Coronary artery calcification (CAC) was defined as CACS > 0. Multivariable logistic regression analysis was performed after adjustment for age, sex, smoking status, liver enzymes, adiposity, dysglycemia, blood pressure, and lipid profile. Multivariable ordinal logistic regression analysis was additionally performed to evaluate the association between M2BPGi levels and CAC severity. Results: The prevalence of CAC increased progressively across M2BPGi quartiles (39.4%, 45.3%, 48.5%, and 57.4% for Q1–Q4, respectively; p < 0.001). In multivariable logistic regression analysis, participants in the highest M2BPGi quartile had significantly higher odds of CAC presence than those in the lowest quartile (OR, 1.32; 95% CI, 1.10–1.58; p = 0.0035). Higher M2BPGi quartiles were also independently associated with greater CAC severity in multivariable ordinal logistic regression analysis (OR, 1.33; 95% CI, 1.13–1.57; p = 0.0007 for Q4 vs. Q1). Conclusions: Higher serum M2BPGi levels were independently associated with both the presence and severity of CAC in individuals with MASLD. These findings suggest that M2BPGi may serve as a potential biomarker for identifying individuals with MASLD at increased risk of subclinical atherosclerosis and may complement conventional cardiovascular risk assessment. Full article

Background and Objectives: Coronary computed tomography angiography (CCTA) has become a central non-invasive imaging modality for the evaluation of suspected chronic coronary syndromes. Nevertheless, referral patterns and sex-related differences in real-world CCTA utilization may vary according to demographic structure, healthcare accessibility, and regional clinical practice. The present study aimed to evaluate age- and sex-related patterns in CCTA referrals and coronary atherosclerotic burden within a real-world Eastern European single-center CCTA referral cohort. Materials and Methods: We performed a retrospective analysis of 2742 consecutive CCTA examinations at a tertiary center in Sibiu, Romania, between March 2019 and January 2025. The demographic profile of the referral cohort was compared with the adult population structure of Sibiu County. Subsequently, an age- and sex-stratified proportional subsample of 397 cases was selected from the CCTA cohort for detailed analysis of sex-related differences regarding coronary artery calcium score (CACS), significant coronary stenoses, and significant cardiovascular event risk. Results: The age distribution of the CCTA referral cohort differed significantly from that of the adult county population (p < 0.01), with referrals concentrated predominantly between 55 and 79 years of age. Female patients were overall more frequently represented within the referral cohort compared with the underlying county population; however, males demonstrated significantly higher coronary artery calcium scores, a greater prevalence of significant coronary stenoses, and higher revascularization risk compared with females—particularly between 50 and 79 years of age—within the stratified proportional subsample. In contrast, patients younger than 40 years demonstrated very low rates of significant coronary disease regardless of sex. Conclusions: This study provides a real-world perspective on age- and sex-related patterns in CCTA utilization and coronary atherosclerotic burden within an Eastern European imaging center. The findings highlight the interaction between demographic structure, guideline-directed diagnostic strategies, and coronary imaging utilization in routine clinical practice. Full article

Cardiovascular disease (CVD) prevention depends on accurate risk stratification before symptoms develop. Standard tools such as the Pooled Cohort Equations, QRISK3, and SCORE2 require laboratory data and are less informative in borderline-risk individuals, creating a role for accessible adjuncts. Retinal imaging directly visualizes the systemic microvasculature, and deep-learning oculomics may provide complementary risk information. Reti-CVD generates a three-tier classification from a retinal photograph and is among the more extensively validated retinal-AI tools. This narrative review evaluates its clinical positioning and implementation as an exemplar rather than a product endorsement, organizing evidence by cohort, comparing the approach with established scores and subclinical atherosclerosis markers, and considering implementation, regulation, and equity. RetiCAC was trained using coronary artery calcium as a surrogate label; subsequent Reti-CVD studies included UK Biobank, Singapore SEED, and CMERC-HI. Reported discrimination was approximately 0.75 by the Harrell C-index, with modest reclassification improvement, particularly in borderline-risk groups. As the commercial product DrNoon for CVD, the tool holds marketing authorization from Korea’s Ministry of Food and Drug Safety (MFDS) and, according to the manufacturer, CE certification under the EU Medical Device Regulation (MDR); in Korea it entered outpatient practice through a time-limited non-covered (out-of-pocket) assessment-deferral pathway, and it has not yet received US FDA authorization. Most evidence originates from one research group and one commercial algorithm, and no randomized or outcome-based study has shown that Reti-CVD-guided care improves clinical outcomes. These observational findings remain hypothesis-generating rather than evidence of established clinical utility. Reti-CVD is therefore best regarded as a non-invasive risk enhancer for borderline/intermediate-risk reclassification, not as a tool of established clinical utility; independent validation, intervention trials, and cost-effectiveness and reimbursement evidence are needed before broad integration. Full article

Background: Cardiovascular disease (CVD) remains the leading cause of mortality across the European Union (EU), with a fourfold to fivefold east–west gradient in standardized circulatory-disease mortality. Romania ranks second highest in the EU (787 per 100,000 inhabitants in 2023). Primary-prevention practice is organized around two quantitative frameworks—the 2021 European Society of Cardiology (ESC) SCORE2/SCORE2-OP system and the 2018/2019 American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Equations (PCE)—which converge on therapy but diverge on patient selection. Methods: We conducted a structured narrative review (SANRA-compliant) of contemporary primary-prevention guidelines, validation studies, key trials of risk-modifier interventions, and Romanian epidemiological data through April 2026. On this basis, we developed ROMA-CV (Risk Of Multifactorial Atherosclerosis—CardioVascular) as a conceptual, country-specific risk-stratification framework anchored to existing Class I/IIa recommendations or Level A/B evidence, rather than as a fully developed, ready-to-use clinical tool Results: Four structural limitations of SCORE2 are clinically consequential in Romania: (i) an age floor of 40 years that excludes the population in which premature myocardial infarction is most preventable; (ii) a country-level calibration coefficient applied to individuals; (iii) permissive treatment of lipoprotein(a) [Lp(a)]; and (iv) an under-emphasis of subclinical-atherosclerosis imaging. We propose ROMA-CV (Risk Of Multifactorial Atherosclerosis—Cardiovascular), a four-step algorithm retaining SCORE2 as the quantitative spine while embedding once-in-a-lifetime Lp(a) measurement, a mandatory amplifier checklist, and selective coronary artery calcium (CAC) or carotid/femoral ultrasound imaging. Conclusions: ROMA-CV is a hypothesis-generating proposal that operationalizes existing evidence-based recommendations into a deterministic Romanian pathway aligned with the 2025–2030 Romanian National Plan for Non-Communicable Diseases and the EU Cardiovascular Health Plan. The algorithm is not a validated clinical decision tool and requires prospective external validation in Romanian cohorts—alongside feasibility, cost-effectiveness, and implementation studies—before any consideration of routine clinical adoption. Full article

Cardiac computed tomography (CT) has evolved into a pivotal tool in precision cardiology, enabling comprehensive, non-invasive evaluation of coronary anatomy, plaque composition, vascular function, and inflammation. From calcium scoring to advanced physiological imaging, CT now integrates multiple layers of cardiovascular information within a unified diagnostic framework. Coronary artery calcium (CAC) quantification provides a robust, reproducible measure of atherosclerotic burden and refines risk estimation beyond traditional algorithms, particularly in asymptomatic individuals with an intermediate likelihood. Building upon this anatomical foundation, coronary CT angiography (CCTA) extends evaluation to the anatomical and morphological characterization of coronary artery disease (CAD), identifying both obstructive and non-obstructive plaques with high prognostic accuracy. The addition of CT-derived fractional flow reserve (FFR-CT) and stress perfusion CT (CTP) bridges anatomy and physiology, improving identification of flow-limiting stenoses and guiding revascularization decisions while reducing unnecessary invasive procedures. Beyond luminal assessment, CT-derived biomarkers such as the perivascular fat attenuation index (pFAI) have introduced a new dimension of vascular inflammation imaging, revealing residual risk even in patients without significant stenosis and suggesting novel pathways for individualized therapeutic targeting. Driven by advances in artificial intelligence and photon-counting detector technology, cardiac CT is transitioning from a purely diagnostic modality to an integrative platform for cardiovascular phenotyping. Taken as a whole, this integration of structural, functional, and biological data provides a genuinely holistic view of coronary health. In practical terms, it shifts clinical decision-making from population-based risk models toward precision-guided patient-specific strategies. Full article

Background: Inflammation and lipid metabolism play critical roles in coronary artery calcium (CAC) progression. This study aimed to investigate the relationship between neutrophil-to-high-density lipoprotein-cholesterol ratio (NHR) and CAC score. Methods: This cross-sectional study included 2193 eligible participants from Sichuan Provincial People’s Hospital between November 2015 and July 2025. The correlation between NHR and CAC score was evaluated using multivariable logistic and multinomial logistic regression models. Restricted cubic splines (RCS) were employed to assess potential nonlinear relationships. Sensitivity analyses and subgroup analyses were performed to test the robustness of the findings. Results: Among 2193 eligible participants, 64.89% had detectable CAC. Higher NHR levels were significantly associated with increased CAC prevalence. After adjustment for multiple confounders, each 1-unit increase in NHR was associated with 9.0% higher odds of CAC (odds ratio (OR): 1.09, [95% confidence interval (CI) 1.03–1.16], p = 0.002). Compared with the lowest NHR quartile, the highest quartile was associated with modestly higher odds of CAC (OR: 1.43 [95% CI 1.05–1.95], p = 0.022). In multinomial analyses, NHR was modestly but significantly associated with CAC across mild, moderate, and severe calcification stages. The RCS analysis showed a linear relationship between NHR and CAC. Subgroup analyses and sensitivity analyses confirmed the robustness of the findings. Conclusions: Elevated NHR was associated with an increased likelihood of CAC. As a simple and readily available marker, NHR may reflect inflammatory and lipid metabolic status related to subclinical atherosclerosis, although its clinical utility requires further confirmation. Full article