AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Life’s Essential 8 and Subclinical Plaque Among People with High Coronary Artery Disease Polygenic Risk Score in the PROACT Trials
By Abou-Karam R, Thompson AG, Yudelman M et al.
Background: The PROACT trials enrolled individuals with high coronary artery disease polygenic risk score (CAD PRS) but low clinical risk, in whom we previously reported a high prevalence of subclinical plaque on coronary CT angiography (CCTA). Prior observational studies suggested that adopting a healthy lifestyle might reduce the risk of CAD among people with high CAD PRS. It remains unclear whether the prevalence of subclinical plaque among those with high CAD PRS varies by Life’s Essential 8. Methods: The PROACT trials (PROACT 1 NCT05819814; PROACT 2 NCT05850091) enrolled adults aged 40-75 years with high CAD PRS, without cardiovascular disease, and not on lipid-lowering therapy between November 2023 and May 2026. Life’s Essential 8 (LE8) was evaluated at enrollment and CCTA was obtained. We studied the association of LE8 and its components with baseline plaque in age and sex-adjusted models. We also evaluated the prevalence of plaque by strata of LE8, high (LE8 ≥80), moderate (LE8 50-79), and low (LE8 <50) cardiovascular health. Results: Among 394 participants (mean age 55.6±9.1 years, 61.9% female) who have completed both baseline CCTA and LE8 evaluation to-date, plaque prevalence was 70.0% (95% CI 62.2-76.8) in males and 38.9% (33.0-45.2) in females. PROACT participants had fairly favorable cardiovascular health (mean LE8 72.8 ± 11.6). Only 12 (3.0%) participants had low cardiovascular health, while 263 (66.8%) had moderate and 119 (30.2%) high cardiovascular health. There was no association of LE8 score with plaque presence in age- and sex-adjusted models (OR 0.89 per 10 points, 95% CI 0.73-1.09). Plaque presence was high even in participants with high cardiovascular health: 52 of 119 (43.7%) with high, 141 of 263 (53.6%) with moderate, and 7 of 12 (58.3%) with low cardiovascular health had plaque (Figure) . There were no differences in subclinical plaque presence across individual LE8 components and in sex-stratified analysis. Conclusions: In this study of adults with high CAD PRS, subclinical plaque prevalence is high even in the presence of favorable Life’s Essential 8, suggesting that pharmacological intervention is warranted. These findings do not negate the importance of heart healthy lifestyle in people with high genetic risk. The ongoing PROACT 1 randomized controlled trial is evaluating whether disclosure of a high CAD PRS among people without plaque will improve Life’s Essential 8 over a one-year period compared to standard of care.