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

Leticia Fernandez-Friera, Jose L. Penalvo, Antonio Fernandez-Ortiz, Borja Ibanez, Beatriz Lopez-Melgar, Martin Laclaustra, Belen Oliva, Agustin Mocoroa, Jose Mendiguren, Vicente Martinez de Vega, Laura Garcia, Jesus Molina, Javier Sanchez-Gonzalez, Gabriela Guzman, Juan C. Alonso-Farto, Eliseo Guallar, Fernando Civeira, Henrik Sillesen, Stuart Pocock, Jose M. OrdovasGines Sanz, Luis Jesus Jimenez-Borreguero, Valentin Fuster

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    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
    Issue number24
    Pages (from-to)2104-2113
    Number of pages10
    Publication statusPublished - 2015


    • atherosclerosis
    • epidemiology
    • multidetector computed tomography
    • population
    • risk assessment
    • ultrasonography
    • RISK
    • EVENTS
    • DESIGN
    • HEALTH
    • PLAQUE


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