Please use this identifier to cite or link to this item:http://hdl.handle.net/20.500.12105/8352
Prevalence, Vascular Distribution, and Multiterritorial Extent of Subclinical Atherosclerosis in a Middle-Aged Cohort: The PESA (Progression of Early Subclinical Atherosclerosis) Study
Fernandez-Friera, Leticia CNIC | Penalvo, Jose L CNIC | Fernandez-Ortiz, Antonio CNIC | Ibanez, Borja CNIC | Lopez-Melgar, Beatriz CNIC | Laclaustra, Martin CNIC | Oliva, Belen CNIC | Mocoroa, Agustín | Mendiguren, Jose M | Martínez de Vega, Vicente | Garcia, Laura CNIC | Molina, Jesus CNIC | Sanchez-Gonzalez, Javier CNIC | Guzman-Martinez, Gabriela CNIC | Alonso-Farto, Juan C CNIC | Guallar, Eliseo CNIC | Civeira, Fernando | Sillesen, Henrik CNIC | Pocock, Stuart CNIC | Ordovas, Jose M CNIC | Sanz, Gines CNIC | Jimenez-Borreguero, Luis J. CNIC | Fuster, Valentin CNIC
Circulation. 2015; 131(24):2104-13
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.
atherosclerosis | epidemiology | multidetector computed tomography | population | risk assessment | ultrasonography
Adult | Age Factors | Ankle Brachial Index | Aorta, Abdominal | Aortic Diseases | Aortography | Asymptomatic Diseases | Atherosclerosis | Calcinosis | Carotid Artery Diseases | Comorbidity | Coronary Angiography | Coronary Artery Disease | Disease Progression | Female | Femoral Artery | Follow-Up Studies | Humans | Iliac Artery | Male | Middle Aged | Multidetector Computed Tomography | Plaque, Atherosclerotic | Prevalence | Prospective Studies | Risk Factors | Spain | Ultrasonography
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