ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Atherosclerosis and Vascular Medicine
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1629984
Pericoronary Adipose Tissue Inflammation Mediates the Atherogenic Effects o f Lipids on Multivessel Coronary Artery Disease: A CCTA-Based Radiomics Analysis
Provisionally accepted
- Yanan University Affiliated Hospital, Yanan, China
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Objective: The atherogenic index of plasma (AIP) is a robust predictor of cardiovascular risk. However, its mechanism of action in the severity of coronary artery disease (CAD) remains unknown. We investigated whether pericoronary adipose tissue inflammation (assessed using the fat attenuation index [FAI] ) mediates the association between AIP and CAD in middle-aged and older adults. Methods: A total of 450 patients who underwent coronary computed tomography angiography (CCTA) at Yan'an University Affiliated Hospital (2022–2024) were enrolled in this study. CAD severity was defined as multivessel CAD (MVCAD; ≥50% stenosis in ≥2 arteries). FAI was measured around the right coronary artery (RCA-FAI) using a standardized radiomics protocol. Logistic regression and mediation analyses (PROCESS macro, 1,000 bootstrap samples) were used to quantify these associations. Results: AIP independently predicted MVCAD (OR=2.35, 95% CI:1.96⁓5.10, P<0.01).RCA-FAI showed a dose-dependent CAD risk (OR=1.33 per 1-unit increase, P<0.01), with a 33% higher risk per FAI increment. Mediation analysis revealed that the RCA-FAI explained 27.9% of the AIP-MVCAD association (P<0.05). Stratification by glucose metabolism status confirmed the consistent role of RCA-FAI across subgroups, whereas the AIP-CAD association was significant only in normoglycemic individuals. Conclusion: This is the first study to demonstrate that coronary arterial inflammation (RCA-FAI) partially mediates the atherogenic effects of AIP on MVCAD, suggesting a dual pathway of lipid-driven inflammation and metabolic dysregulation. Our findings highlight RCA-FAI as a promising imaging biomarker for CAD risk stratification, irrespective of glucose metabolism status.
Keywords: Atherogenic index of plasma, Coronary Atherosclerotic Disease Severity, Coronary Arterial Inflammation, Glucose metabolism status, Mediation analysis
Received: 16 May 2025; Accepted: 27 Aug 2025.
Copyright: © 2025 Du, Zheng, Yao, Zhou and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Linjuan Li, Yanan University Affiliated Hospital, Yanan, China
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