Format

Send to

Choose Destination
Circulation. 2015 Jun 16;131(24):2104-13. doi: 10.1161/CIRCULATIONAHA.114.014310. Epub 2015 Apr 16.

Prevalence, Vascular Distribution, and Multiterritorial Extent of Subclinical Atherosclerosis in a Middle-Aged Cohort: The PESA (Progression of Early Subclinical Atherosclerosis) Study.

Author information

1
From Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (L.F.-F., J.L.P., A.F.-O., B.I., B.L.-M., M.L., B.O., L.G., J. Molina, G.G., H.S., S.P., J.M.O., G.S., L.J.J.-B., V.F.); Hospital Universitario Montepríncipe, Madrid, Spain (L.F.-F., B.L.-M.); Universidad Autónoma de Madrid, Spain (M.L.); St. Louis University, St. Louis, MO (M.L.); Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain (A.F.-O., B.I.); Banco de Santander, Madrid, Spain (A.M., J. Mendiguren); Hospital Universitario Quirón, Madrid, Spain (V.M.d.V.); Philips Healthcare, Madrid, Spain (J.S.-G.); Hospital Universitario La Paz, Madrid, Spain (G.G.); Hospital General Universitario Gregorio Marañón, Madrid, Spain (J.C.A.-F.); Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (E.G.); Lipids Unit and Molecular Research Laboratory, Hospital Universitario Miguel Servet, Instituto Aragonés de Ciencias de Salud, Zaragoza, Spain (F.C.); Rigshospitalet, University of Copenhagen, Denmark (H.S.); London School of Hygiene & Tropical Medicine, UK (S.P.); US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA (J.M.O.); Hospital Universitario La Princesa, Madrid, Spain (L.J.J.-B.); and Mount Sinai School of Medicine, New York (V.F.).
2
From Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (L.F.-F., J.L.P., A.F.-O., B.I., B.L.-M., M.L., B.O., L.G., J. Molina, G.G., H.S., S.P., J.M.O., G.S., L.J.J.-B., V.F.); Hospital Universitario Montepríncipe, Madrid, Spain (L.F.-F., B.L.-M.); Universidad Autónoma de Madrid, Spain (M.L.); St. Louis University, St. Louis, MO (M.L.); Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain (A.F.-O., B.I.); Banco de Santander, Madrid, Spain (A.M., J. Mendiguren); Hospital Universitario Quirón, Madrid, Spain (V.M.d.V.); Philips Healthcare, Madrid, Spain (J.S.-G.); Hospital Universitario La Paz, Madrid, Spain (G.G.); Hospital General Universitario Gregorio Marañón, Madrid, Spain (J.C.A.-F.); Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (E.G.); Lipids Unit and Molecular Research Laboratory, Hospital Universitario Miguel Servet, Instituto Aragonés de Ciencias de Salud, Zaragoza, Spain (F.C.); Rigshospitalet, University of Copenhagen, Denmark (H.S.); London School of Hygiene & Tropical Medicine, UK (S.P.); US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA (J.M.O.); Hospital Universitario La Princesa, Madrid, Spain (L.J.J.-B.); and Mount Sinai School of Medicine, New York (V.F.). valentin.fuster@mountsinai.org.

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.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01410318.

KEYWORDS:

atherosclerosis; epidemiology; multidetector computed tomography; population; risk assessment; ultrasonography

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center