Abstract
BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of global morbidity and mortality, underscoring the need for improved early detection strategies for preclinical atherosclerosis. This study evaluated comprehensive multimodal cardiovascular risk predictors-clinical, biochemical, and vascular imaging parameters-in dyslipidemic adults without established ASCVD. METHODS: A total of 847 adults underwent standardized clinical assessment, laboratory profiling, and duplex-based vascular imaging, including carotid intima-media thickness (IMT), plaque assessment, flow-mediated dilation (FMD), and ankle-brachial index. Statistical analyses included multivariate logistic regression, receiver operating characteristic (ROC) curve analysis, model calibration metrics, and correlation matrices using Pearson or Spearman tests as appropriate. High-density lipoprotein cholesterol (HDL-C) exhibited a strong inverse correlation with AIP (r = -0.57, P < .001). RESULTS: Triglycerides (TG) demonstrated a strong positive correlation with the atherogenic index of plasma (AIP) (r = 0.80, P < .001). Moderate correlations were observed between age and left ventricular mass index (r = 0.31, P < .001), age and fibrinogen (r = 0.32, P < .001), HbA1c and TG (r = 0.26, P < .001), and HbA1c and AIP (r = 0.30, P < .001). ASCVD and atherosclerosis total score positivity were independently associated with age, HbA1c, IMT, and FMD in multivariable analyses, while model discrimination remained robust (area under the curve values reported). CONCLUSION: Multimodal integration of clinical, biochemical, and vascular imaging markers provides meaningful refinement of cardiovascular risk stratification and may enhance early detection of preclinical ASCVD.