Coronary artery disease (CAD) remains a leading cause of death worldwide, and established risk factors include age, male sex, obesity, smoking, diabetes, hypertension, and dyslipidemia. Despite known risk factors, CAD pathogenesis is not fully explained. Gallstones share several risk factors with CAD, and prior studies have reported an association between gallstones and clinical CAD even after adjustment for confounders. However, evidence on the relationship between gallstones and subclinical coronary atherosclerosis is inconsistent, and earlier work did not consider coronary plaque type.
This study therefore investigated whether the presence of gallstones is associated with subclinical coronary atherosclerosis in asymptomatic Korean adults, with specific attention to plaque composition assessed by coronary computed tomographic angiography (CCTA).
The authors performed a retrospective analysis of adults aged 20 years or older who underwent self-referred CCTA as part of a general health examination at Ulsan University Hospital’s Health Promotion Center between January 2009 and March 2020. Of 10,581 individuals initially identified, 9,113 met inclusion criteria after applying exclusion criteria detailed in the flow chart. Participants had no history of coronary artery disease.
Clinical and laboratory data were obtained from electronic medical records and a clinical data warehouse. Standardized measurements during health examinations included body weight, height, waist circumference, and blood pressure. Blood tests after overnight fasting provided hemoglobin A1c, fasting glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), creatinine, uric acid, bilirubin, liver enzymes, gamma-glutamyl transpeptidase, alkaline phosphatase, and C-reactive protein (CRP). All participants had a 12-lead electrocardiogram, and echocardiography was used to assess left ventricular ejection fraction.
Obesity classification followed the World Health Organization Asian-specific body mass index cutoff (≥25 kg/m2). Diabetes mellitus was defined by HbA1c ≥6.5%, fasting plasma glucose ≥126 mg/dL, or a self-reported history of diabetes or diabetes treatment.
Coronary plaque type and severity of subclinical coronary atherosclerosis were evaluated using CCTA. Plaque composition was categorized, and a diameter stenosis of ≥50% was used to define clinically significant coronary artery stenosis. The study specifically reported on the presence of noncalcified plaque, which the authors described as a higher-risk plaque phenotype.
The association between gallstones and subclinical coronary atherosclerosis was evaluated using logistic regression analyses adjusting for potential confounders. To address imbalances between groups, propensity score matching analyses were also conducted. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) and p-values were reported for associations of interest.
Among the 9,113 asymptomatic participants (mean age 53.7 ± 8.0 years; 5,907 men [64.8%]), 503 individuals (5.5%) had gallstones diagnosed by transabdominal ultrasonography.
After multivariable adjustment for established risk factors, gallstones were significantly associated with the presence of noncalcified plaque on CCTA (adjusted OR 1.728; 95% CI 1.267–2.357; p = 0.001). Gallstones were also associated with significant coronary artery stenosis (adjusted OR 1.386; 95% CI 1.002–1.917; p = 0.049).
Propensity score matching analyses were used to further evaluate the robustness of these associations; the source reports that both logistic regression and propensity score matching supported the observed relationships. Detailed tables and a participant flow figure were provided in the original article to document sample selection and analytic results.
In this large retrospective cohort of asymptomatic Korean adults undergoing health screening with CCTA, the presence of gallstones was independently associated with noncalcified plaque, which the authors interpret as a high-risk plaque phenotype, and with clinically significant coronary stenosis (≥50% diameter reduction). These findings suggest that gallstones may mark individuals at higher likelihood of subclinical coronary atherosclerosis, beyond shared conventional risk factors.
The authors note prior inconsistent findings in the literature, including studies that found no association between gallstones and coronary artery calcification; they hypothesized that differences in plaque composition may account for divergent results. By differentiating plaque types on CCTA, this study addressed that gap and identified a specific association with noncalcified plaque.
Given that noncalcified plaque and significant stenosis are often linked to worse cardiac outcomes, the authors recommend awareness of the potential for subclinical coronary atherosclerosis in patients with gallstones and attention to cardiovascular risk factor management.
The retrospective study received approval from the Institutional Review Board of Ulsan University Hospital (IRB file No. UUH 2023-07-065) with waiver of informed consent. The underlying data contain potentially identifiable patient information and are not publicly available; access can be requested from the Ulsan University Hospital Institutional Data Access Committee subject to institutional criteria.
Funding was provided by grants from the Korea Health Technology R&D Project through KHIDI and the Korea Health Information Service; funders did not influence study conduct or reporting. The authors declared no competing interests.
The source article provides more detailed methods, tables, and figures (including participant flow and analytic tables). Specifics beyond the reported adjusted odds ratios, such as full covariate lists in multivariable models, matched sample characteristics after propensity score matching, and absolute event counts by plaque type, are presented in the original paper. Where details are not restated here, they were not reported in the provided source excerpt.