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Region Hovedstaden - en del af Københavns Universitetshospital
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Prevalence, Vascular Distribution, and Multiterritorial Extent of Subclinical Atherosclerosis in a Middle-Aged Cohort: The PESA (Progression of Early Subclinical Atherosclerosis) Study

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  • Leticia Fernández-Friera
  • José L Peñalvo
  • Antonio Fernández-Ortiz
  • Borja Ibañez
  • Beatriz López-Melgar
  • Martín Laclaustra
  • Belén Oliva
  • Agustín Mocoroa
  • José Mendiguren
  • Vicente Martínez de Vega
  • Laura García
  • Jesús Molina
  • Javier Sánchez-González
  • Gabriela Guzmán
  • Juan C Alonso-Farto
  • Eliseo Guallar
  • Fernando Civeira
  • Henrik Sillesen
  • Stuart Pocock
  • José M Ordovás
  • Ginés Sanz
  • Luis Jesús Jiménez-Borreguero
  • Valentín Fuster
Vis graf over relationer

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.

OriginalsprogEngelsk
TidsskriftCirculation (Baltimore)
Vol/bind131
Udgave nummer24
Sider (fra-til)2104-13
Antal sider10
ISSN0009-7322
DOI
StatusUdgivet - 16 jun. 2015

ID: 45697521