Coronary artery disease in Behçet’s syndrome: a coronary computed tomography angiography study

Abstract Objectives Despite significant vascular inflammation, the relationship between Behçet's syndrome (BS) and atherosclerotic cardiovascular (CV) disease remains unclear. This study aimed to evaluate coronary artery involvement in asymptomatic male BS patients and matched controls using coronary computed tomography angiography (CCTA). Methods This cross-sectional study included 178 male BS patients (mean age: 40.78±7.95) and 139 male controls (mean age: 40.48±7.17). Coronary lesions were classified as stenosis, aneurysm, arteritis, or occlusion. Agatston calcium scores were calculated. All CCTA images were evaluated independently by two radiologists, with excellent inter-observer agreement. Demographic/clinical characteristics and traditional CV risk factors were also evaluated. Results BS patients and controls were comparable with regard to most CV risk factors. Any coronary lesion prevalence was similar between BS patients and controls (23.6% vs 25.9%, p = 0.694), as were stenosis rates (20.8% vs 25.9%, p = 0.286) and Agatston scores. However, aneurysms (5.1%), arteritis (4.0%), and total occlusions (1.7%) occurred only in BS patients. Age was an independent predictor of any coronary lesion (OR 1.113, 95% CI 1.047–1.184, p < 0.001), while venous involvement showed protective association (OR 0.275, 95% CI 0.114–0.664, p = 0.004). Clinical risk stratification identified arterial and neurological involvement as highest risk, while venous involvement showed lowest risk. Conclusions BS does not appear to accelerate atherosclerosis, in contrast to other systemic rheumatic diseases. Instead, coronary involvement in BS is characterized by vasculitis-related lesions such as arteritis, aneurysms, and total occlusions. Clinical phenotypes rather than traditional CV risk factors determine coronary involvement patterns. Distinct disease phenotypes appear to confer differential risks for coronary involvement.