TY - JOUR

T1 - Prevalence, Vascular Distribution, and Multiterritorial Extent of Subclinical Atherosclerosis in a Middle-Aged Cohort

T2 - The PESA (Progression of Early Subclinical Atherosclerosis) Study

AU - Fernández-Friera, Leticia

AU - Peñalvo, José L

AU - Fernández-Ortiz, Antonio

AU - Ibañez, Borja

AU - López-Melgar, Beatriz

AU - Laclaustra, Martín

AU - Oliva, Belén

AU - Mocoroa, Agustín

AU - Mendiguren, José

AU - Martínez de Vega, Vicente

AU - García, Laura

AU - Molina, Jesús

AU - Sánchez-González, Javier

AU - Guzmán, Gabriela

AU - Alonso-Farto, Juan C

AU - Guallar, Eliseo

AU - Civeira, Fernando

AU - Sillesen, Henrik

AU - Pocock, Stuart

AU - Ordovás, José M

AU - Sanz, Ginés

AU - Jiménez-Borreguero, Luis Jesús

AU - Fuster, Valentín

N1 - © 2015 American Heart Association, Inc.

PY - 2015/6/16

Y1 - 2015/6/16

N2 - BACKGROUND: Data are limited on the presence, distribution, and extent of subclinical atherosclerosis in middle-aged populations.METHODS AND RESULTS: The PESA (Progression of Early Subclinical Atherosclerosis) study prospectively enrolled 4184 asymptomatic participants 40 to 54 years of age (mean age, 45.8 years; 63% male) to evaluate the systemic extent of atherosclerosis in the carotid, abdominal aortic, and iliofemoral territories by 2-/3-dimensional ultrasound and coronary artery calcification by computed tomography. The extent of subclinical atherosclerosis, defined as presence of plaque or coronary artery calcification ≥1, was classified as focal (1 site affected), intermediate (2-3 sites), or generalized (4-6 sites) after exploration of each vascular site (right/left carotids, aorta, right/left iliofemorals, and coronary arteries). Subclinical atherosclerosis was present in 63% of participants (71% of men, 48% of women). Intermediate and generalized atherosclerosis was identified in 41%. Plaques were most common in the iliofemorals (44%), followed by the carotids (31%) and aorta (25%), whereas coronary artery calcification was present in 18%. Among participants with low Framingham Heart Study (FHS) 10-year risk, subclinical disease was detected in 58%, with intermediate or generalized disease in 36%. When longer-term risk was assessed (30-year FHS), 83% of participants at high risk had atherosclerosis, with 66% classified as intermediate or generalized.CONCLUSIONS: Subclinical atherosclerosis was highly prevalent in this middle-aged cohort, with nearly half of the participants classified as having intermediate or generalized disease. Most participants at high FHS risk had subclinical disease; however, extensive atherosclerosis was also present in a substantial number of low-risk individuals, suggesting added value of imaging for diagnosis and prevention.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01410318.

AB - BACKGROUND: Data are limited on the presence, distribution, and extent of subclinical atherosclerosis in middle-aged populations.METHODS AND RESULTS: The PESA (Progression of Early Subclinical Atherosclerosis) study prospectively enrolled 4184 asymptomatic participants 40 to 54 years of age (mean age, 45.8 years; 63% male) to evaluate the systemic extent of atherosclerosis in the carotid, abdominal aortic, and iliofemoral territories by 2-/3-dimensional ultrasound and coronary artery calcification by computed tomography. The extent of subclinical atherosclerosis, defined as presence of plaque or coronary artery calcification ≥1, was classified as focal (1 site affected), intermediate (2-3 sites), or generalized (4-6 sites) after exploration of each vascular site (right/left carotids, aorta, right/left iliofemorals, and coronary arteries). Subclinical atherosclerosis was present in 63% of participants (71% of men, 48% of women). Intermediate and generalized atherosclerosis was identified in 41%. Plaques were most common in the iliofemorals (44%), followed by the carotids (31%) and aorta (25%), whereas coronary artery calcification was present in 18%. Among participants with low Framingham Heart Study (FHS) 10-year risk, subclinical disease was detected in 58%, with intermediate or generalized disease in 36%. When longer-term risk was assessed (30-year FHS), 83% of participants at high risk had atherosclerosis, with 66% classified as intermediate or generalized.CONCLUSIONS: Subclinical atherosclerosis was highly prevalent in this middle-aged cohort, with nearly half of the participants classified as having intermediate or generalized disease. Most participants at high FHS risk had subclinical disease; however, extensive atherosclerosis was also present in a substantial number of low-risk individuals, suggesting added value of imaging for diagnosis and prevention.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01410318.

KW - Adult

KW - Age Factors

KW - Ankle Brachial Index

KW - Aorta, Abdominal

KW - Aortic Diseases

KW - Aortography

KW - Asymptomatic Diseases

KW - Atherosclerosis

KW - Calcinosis

KW - Carotid Artery Diseases

KW - Comorbidity

KW - Coronary Angiography

KW - Coronary Artery Disease

KW - Disease Progression

KW - Female

KW - Femoral Artery

KW - Follow-Up Studies

KW - Humans

KW - Iliac Artery

KW - Male

KW - Middle Aged

KW - Multidetector Computed Tomography

KW - Plaque, Atherosclerotic

KW - Prevalence

KW - Prospective Studies

KW - Risk Factors

KW - Spain

U2 - 10.1161/CIRCULATIONAHA.114.014310

DO - 10.1161/CIRCULATIONAHA.114.014310

M3 - Journal article

C2 - 25882487

VL - 131

SP - 2104

EP - 2113

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 24

ER -