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
SN - 0009-7322
VL - 131
SP - 2104
EP - 2113
JO - Circulation (Baltimore)
JF - Circulation (Baltimore)
IS - 24
ER -