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.