Prevalence, vascular distribution, and multiterritorial extent of subclinical atherosclerosis in a middle-aged cohort the PESA (Progression of Early Subclinical Atherosclerosis) study

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. OrdovásGinés Sanz, Luis Jesús Jiménez-Borreguero, Valentín Fuster

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2104-2113
Number of pages10
JournalCirculation
Volume131
Issue number24
DOIs
StatePublished - Jun 16 2015

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Keywords

  • Atherosclerosis
  • Epidemiology
  • Multidetector computed tomography
  • Population
  • Risk assessment
  • Ultrasonography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Fernández-Friera, L., Peñalvo, J. L., Fernández-Ortiz, A., Ibañez, B., López-Melgar, B., Laclaustra, M., Oliva, B., Mocoroa, A., Mendiguren, J., De Vega, V. M., García, L., Molina, J., Sánchez-González, J., Guzmán, G., Alonso-Farto, J. C., Guallar, E., Civeira, F., Sillesen, H., Pocock, S., ... Fuster, V. (2015). Prevalence, vascular distribution, and multiterritorial extent of subclinical atherosclerosis in a middle-aged cohort the PESA (Progression of Early Subclinical Atherosclerosis) study. Circulation, 131(24), 2104-2113. https://doi.org/10.1161/CIRCULATIONAHA.114.014310