Association Between Circulating Branched-Chain Amino Acid Levels and Carotid Vulnerable Plaque: A Retrospective Study with Internal Validation

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Abstract
Background BCAAs are linked to insulin resistance and CVD but their association with carotid plaque vulnerability is unknown. This retrospective study investigated serum BCAA and vulnerable plaque with internal validation. Methods We retrospectively reviewed records of 98 hospitalized patients who had undergone carotid ultrasound and LC-MS/MS. Patients were classified as vulnerable (n = 32) or stable (n = 46) plaque. Results Total BCAA higher in vulnerable vs stable plaque (530.9+/-169.3 vs 462.2+/-94.8 umol/L, d = 0.50, P = 0.043). Adjusted OR = 2.01 (95%CI 1.14–3.53). Bootstrap d = 0.49 (95%CI 0.07–0.89). Direction consistency 92.2%. Conclusions Elevated BCAA independently associated with vulnerable plaque, stable across internal validation. BCAAs may be biomarkers for plaque risk stratification.