Fernandez-Friera, LeticiaPeñalvo, Jose LFernandez-Ortiz, AntonioIbáñez, BorjaLopez-Melgar, BeatrizLaclaustra, MartinOliva, BelenMocoroa, AgustínMendiguren, Jose MMartínez de Vega, VicenteGarcia, LauraMolina, JesusSanchez-Gonzalez, JavierGuzman-Martinez, GabrielaAlonso-Farto, Juan CGuallar, EliseoCiveira, FernandoSillesen, HenrikPocock, StuartOrdovas, Jose MSanz, GinesJimenez-Borreguero, Luis J.Fuster, Valentin2019-09-162019-09-162015-06-16Circulation. 2015; 131(24):2104-130009-7322http://hdl.handle.net/20.500.12105/8352BACKGROUND: 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.engAMhttp://creativecommons.org/licenses/by-nc-sa/4.0/AtherosclerosisEpidemiologyMultidetector computed tomographyPopulationRisk assessmentUltrasonographyAdultAge FactorsAnkle Brachial IndexAorta, AbdominalAortic DiseasesAortographyAsymptomatic DiseasesAtherosclerosisCalcinosisCarotid Artery DiseasesComorbidityCoronary AngiographyCoronary Artery DiseaseDisease ProgressionFemaleFemoral ArteryFollow-Up StudiesHumansIliac ArteryMaleMiddle AgedMultidetector Computed TomographyPlaque, AtheroscleroticPrevalenceProspective StudiesRisk FactorsSpainUltrasonographyAtribución-NoComercial-CompartirIgual 4.0 Internacional25882487131242104-1310.1161/CIRCULATIONAHA.114.0143101524-4539Circulationopen access