Association of Composite Metabolic Indices and Oxidative Stress Biomarkers with Coronary Atherosclerosis Detected by CT Angiography in Premenopausal Women with Metabolic Syndrome

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Background: Metabolic syndrome (MetS) is increasingly prevalent among premenopausal women and is associated with a higher risk of subclinical atherosclerosis. This study investigated whether composite metabolic indices are more strongly associated than conventional metabolic markers with subclinical coronary artery disease (CAD) detected by coronary computed tomography angiography (CCTA). The potential contribution of oxidative stress markers to early atherosclerosis risk assessment was also evaluated in premenopausal Iranian women. Methods: In this cross-sectional case-control study, 101 women aged 30-50 years who were referred for CCTA were enrolled and classified into MetS and control groups according to The National Cholesterol Education Program, Adult Treatment Panel III (NCEP-ATP III) criteria. Demographic, biochemical, metabolic, oxidative stress, and CCTA data were collected. Atherosclerotic burden was assessed using coronary calcium score, plaque number, plaque volume, and percentage of stenosis. Composite metabolic indices, including Triglyceride glucose (TyG), Atherogenic Index of Plasma (AIP) and others were calculated and correlated with imaging findings. Results: Women with MetS exhibited significantly higher coronary plaque numbers, greater lesions volume, and more extensive calcium accumulation compared to the control group. They also demonstrated poorer metabolic health and elevated oxidative stress, as reflected by lower Total Antioxidant Capacity (TAC) and higher levels of Malondialdehyde (MDA) and Superoxide Dismutase (SOD). While traditional lipid levels showed a weak association with plaque metrics, composite indices (TyG and AIP) demonstrated a strong correlation with plaque burden and CAD risk. Oxidative stress markers may also play a supportive role in the assessment of early vascular injury. Conclusion: MetS is strongly associated with early coronary atherosclerosis in women of reproductive age. Composite indices, especially TyG and AIP, outperform conventional metabolic markers in predicting plaque burden. Their combined use with oxidative stress markers may improve early cardiovascular risk stratification and support targeted preventive strategies in premenopausal women.

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