Subclinical atherosclerosis burden by 3D ultrasound in mid-life: the PESA study

Beatriz López-Melgar; Leticia Fernández-Friera; Belén Oliva; José Manuel García-Ruiz; José Luis Peñalvo; Sandra Gómez-Talavera; Javier Sánchez-González; José María Mendiguren; Borja Ibáñez; Antonio Fernández-Ortiz; Javier Sanz; Valentín Fuster

doi:10.1016/j.jacc.2017.05.033

Subclinical atherosclerosis burden by 3D ultrasound in mid-life: the PESA study

Beatriz López-Melgar, Leticia Fernández-Friera, Belén Oliva, José Manuel García-Ruiz, José Luis Peñalvo, Sandra Gómez-Talavera, Javier Sánchez-González, José María Mendiguren, Borja Ibáñez, Antonio Fernández-Ortiz, Javier Sanz, Valentín Fuster

Research output: Contribution to journal › A1: Web of Science-article › peer-review

Abstract

BACKGROUND: Detection of subclinical atherosclerosis improves risk prediction beyond cardiovascular risk factors (CVRFs) and risk scores, but quantification of plaque burden may improve it further. Novel 3-dimensional vascular ultrasound (3DVUS) provides accurate volumetric quantification of plaque burden.

OBJECTIVES: The authors evaluated associations between 3DVUS-based plaque burden and CVRFs and explored potential added value over simple plaque detection.

METHODS: The authors included 3,860 (92.2%) PESA (Progression of Early Subclinical Atherosclerosis) study participants (age 45.8 ± 4.3 years; 63% men). Bilateral carotid and femoral territories were explored by 3DVUS to determine the number of plaques and territories affected, and to quantify global plaque burden defined as the sum of all plaque volumes. Linear regression and proportional odds models were used to evaluate associations of plaque burden with CVRFs and estimated 10-year cardiovascular risk.

RESULTS: Plaque burden was higher in men (63.4 mm3 [interquartile range (IQR): 23.8 to 144.8 mm3] vs. 25.7 mm3 [IQR: 11.5 to 61.6 mm3] in women; p < 0.001), in the femoral territory (64 mm3 [IQR: 27.6 to 140.5 mm3] vs. 23.1 mm3 [IQR: 9.9 to 48.7 mm3] in the carotid territory; p < 0.001), and with increasing age (p < 0.001). Age, sex, smoking, and dyslipidemia were more strongly associated with femoral than with carotid disease burden, whereas hypertension and diabetes showed no territorial differences. Plaque burden was directly associated with estimated cardiovascular risk independently of the number of plaques or territories affected (p < 0.01).

CONCLUSIONS: 3DVUS quantifies higher plaque burden in men, in the femoral territory, and with increasing age during midlife. Plaque burden correlates strongly with CVRFs, especially at the femoral level, and reflects estimated cardiovascular risk more closely than plaque detection alone. (Progression of Early Subclinical Atherosclerosis [PESA] Study; NCT01410318).

Original language	English
Journal	Journal of the American College of Cardiology
Volume	70
Issue number	3
Pages (from-to)	301-313
Number of pages	13
ISSN	0735-1097
DOIs	https://doi.org/10.1016/j.jacc.2017.05.033
Publication status	Published - 2017
Externally published	Yes

Keywords

Adult
Asymptomatic Diseases
Atherosclerosis/diagnosis
Carotid Arteries/diagnostic imaging
Disease Progression
Female
Femoral Artery/diagnostic imaging
Follow-Up Studies
Humans
Imaging, Three-Dimensional
Male
Middle Aged
Plaque, Atherosclerotic/diagnosis
Prospective Studies
Reproducibility of Results
Ultrasonography/methods

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10.1016/j.jacc.2017.05.033

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López-Melgar, B., Fernández-Friera, L., Oliva, B., García-Ruiz, J. M., Peñalvo, J. L., Gómez-Talavera, S., Sánchez-González, J., Mendiguren, J. M., Ibáñez, B., Fernández-Ortiz, A., Sanz, J., & Fuster, V. (2017). Subclinical atherosclerosis burden by 3D ultrasound in mid-life: the PESA study. Journal of the American College of Cardiology, 70(3), 301-313. https://doi.org/10.1016/j.jacc.2017.05.033

@article{0b3dec198a00438aa354c9f4a986a9a2,

title = "Subclinical atherosclerosis burden by 3D ultrasound in mid-life: the PESA study",

abstract = "BACKGROUND: Detection of subclinical atherosclerosis improves risk prediction beyond cardiovascular risk factors (CVRFs) and risk scores, but quantification of plaque burden may improve it further. Novel 3-dimensional vascular ultrasound (3DVUS) provides accurate volumetric quantification of plaque burden.OBJECTIVES: The authors evaluated associations between 3DVUS-based plaque burden and CVRFs and explored potential added value over simple plaque detection.METHODS: The authors included 3,860 (92.2%) PESA (Progression of Early Subclinical Atherosclerosis) study participants (age 45.8 ± 4.3 years; 63% men). Bilateral carotid and femoral territories were explored by 3DVUS to determine the number of plaques and territories affected, and to quantify global plaque burden defined as the sum of all plaque volumes. Linear regression and proportional odds models were used to evaluate associations of plaque burden with CVRFs and estimated 10-year cardiovascular risk.RESULTS: Plaque burden was higher in men (63.4 mm3 [interquartile range (IQR): 23.8 to 144.8 mm3] vs. 25.7 mm3 [IQR: 11.5 to 61.6 mm3] in women; p < 0.001), in the femoral territory (64 mm3 [IQR: 27.6 to 140.5 mm3] vs. 23.1 mm3 [IQR: 9.9 to 48.7 mm3] in the carotid territory; p < 0.001), and with increasing age (p < 0.001). Age, sex, smoking, and dyslipidemia were more strongly associated with femoral than with carotid disease burden, whereas hypertension and diabetes showed no territorial differences. Plaque burden was directly associated with estimated cardiovascular risk independently of the number of plaques or territories affected (p < 0.01).CONCLUSIONS: 3DVUS quantifies higher plaque burden in men, in the femoral territory, and with increasing age during midlife. Plaque burden correlates strongly with CVRFs, especially at the femoral level, and reflects estimated cardiovascular risk more closely than plaque detection alone. (Progression of Early Subclinical Atherosclerosis [PESA] Study; NCT01410318).",

keywords = "Adult, Asymptomatic Diseases, Atherosclerosis/diagnosis, Carotid Arteries/diagnostic imaging, Disease Progression, Female, Femoral Artery/diagnostic imaging, Follow-Up Studies, Humans, Imaging, Three-Dimensional, Male, Middle Aged, Plaque, Atherosclerotic/diagnosis, Prospective Studies, Reproducibility of Results, Ultrasonography/methods",

author = "Beatriz L{\'o}pez-Melgar and Leticia Fern{\'a}ndez-Friera and Bel{\'e}n Oliva and Garc{\'i}a-Ruiz, {Jos{\'e} Manuel} and Pe{\~n}alvo, {Jos{\'e} Luis} and Sandra G{\'o}mez-Talavera and Javier S{\'a}nchez-Gonz{\'a}lez and Mendiguren, {Jos{\'e} Mar{\'i}a} and Borja Ib{\'a}{\~n}ez and Antonio Fern{\'a}ndez-Ortiz and Javier Sanz and Valent{\'i}n Fuster",

year = "2017",

doi = "10.1016/j.jacc.2017.05.033",

language = "English",

volume = "70",

pages = "301--313",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier",

number = "3",

}

López-Melgar, B, Fernández-Friera, L, Oliva, B, García-Ruiz, JM, Peñalvo, JL, Gómez-Talavera, S, Sánchez-González, J, Mendiguren, JM, Ibáñez, B, Fernández-Ortiz, A, Sanz, J & Fuster, V 2017, 'Subclinical atherosclerosis burden by 3D ultrasound in mid-life: the PESA study', Journal of the American College of Cardiology, vol. 70, no. 3, pp. 301-313. https://doi.org/10.1016/j.jacc.2017.05.033

TY - JOUR

T1 - Subclinical atherosclerosis burden by 3D ultrasound in mid-life: the PESA study

AU - López-Melgar, Beatriz

AU - Fernández-Friera, Leticia

AU - Oliva, Belén

AU - García-Ruiz, José Manuel

AU - Peñalvo, José Luis

AU - Gómez-Talavera, Sandra

AU - Sánchez-González, Javier

AU - Mendiguren, José María

AU - Ibáñez, Borja

AU - Fernández-Ortiz, Antonio

AU - Sanz, Javier

AU - Fuster, Valentín

PY - 2017

Y1 - 2017

N2 - BACKGROUND: Detection of subclinical atherosclerosis improves risk prediction beyond cardiovascular risk factors (CVRFs) and risk scores, but quantification of plaque burden may improve it further. Novel 3-dimensional vascular ultrasound (3DVUS) provides accurate volumetric quantification of plaque burden.OBJECTIVES: The authors evaluated associations between 3DVUS-based plaque burden and CVRFs and explored potential added value over simple plaque detection.METHODS: The authors included 3,860 (92.2%) PESA (Progression of Early Subclinical Atherosclerosis) study participants (age 45.8 ± 4.3 years; 63% men). Bilateral carotid and femoral territories were explored by 3DVUS to determine the number of plaques and territories affected, and to quantify global plaque burden defined as the sum of all plaque volumes. Linear regression and proportional odds models were used to evaluate associations of plaque burden with CVRFs and estimated 10-year cardiovascular risk.RESULTS: Plaque burden was higher in men (63.4 mm3 [interquartile range (IQR): 23.8 to 144.8 mm3] vs. 25.7 mm3 [IQR: 11.5 to 61.6 mm3] in women; p < 0.001), in the femoral territory (64 mm3 [IQR: 27.6 to 140.5 mm3] vs. 23.1 mm3 [IQR: 9.9 to 48.7 mm3] in the carotid territory; p < 0.001), and with increasing age (p < 0.001). Age, sex, smoking, and dyslipidemia were more strongly associated with femoral than with carotid disease burden, whereas hypertension and diabetes showed no territorial differences. Plaque burden was directly associated with estimated cardiovascular risk independently of the number of plaques or territories affected (p < 0.01).CONCLUSIONS: 3DVUS quantifies higher plaque burden in men, in the femoral territory, and with increasing age during midlife. Plaque burden correlates strongly with CVRFs, especially at the femoral level, and reflects estimated cardiovascular risk more closely than plaque detection alone. (Progression of Early Subclinical Atherosclerosis [PESA] Study; NCT01410318).

AB - BACKGROUND: Detection of subclinical atherosclerosis improves risk prediction beyond cardiovascular risk factors (CVRFs) and risk scores, but quantification of plaque burden may improve it further. Novel 3-dimensional vascular ultrasound (3DVUS) provides accurate volumetric quantification of plaque burden.OBJECTIVES: The authors evaluated associations between 3DVUS-based plaque burden and CVRFs and explored potential added value over simple plaque detection.METHODS: The authors included 3,860 (92.2%) PESA (Progression of Early Subclinical Atherosclerosis) study participants (age 45.8 ± 4.3 years; 63% men). Bilateral carotid and femoral territories were explored by 3DVUS to determine the number of plaques and territories affected, and to quantify global plaque burden defined as the sum of all plaque volumes. Linear regression and proportional odds models were used to evaluate associations of plaque burden with CVRFs and estimated 10-year cardiovascular risk.RESULTS: Plaque burden was higher in men (63.4 mm3 [interquartile range (IQR): 23.8 to 144.8 mm3] vs. 25.7 mm3 [IQR: 11.5 to 61.6 mm3] in women; p < 0.001), in the femoral territory (64 mm3 [IQR: 27.6 to 140.5 mm3] vs. 23.1 mm3 [IQR: 9.9 to 48.7 mm3] in the carotid territory; p < 0.001), and with increasing age (p < 0.001). Age, sex, smoking, and dyslipidemia were more strongly associated with femoral than with carotid disease burden, whereas hypertension and diabetes showed no territorial differences. Plaque burden was directly associated with estimated cardiovascular risk independently of the number of plaques or territories affected (p < 0.01).CONCLUSIONS: 3DVUS quantifies higher plaque burden in men, in the femoral territory, and with increasing age during midlife. Plaque burden correlates strongly with CVRFs, especially at the femoral level, and reflects estimated cardiovascular risk more closely than plaque detection alone. (Progression of Early Subclinical Atherosclerosis [PESA] Study; NCT01410318).

KW - Adult

KW - Asymptomatic Diseases

KW - Atherosclerosis/diagnosis

KW - Carotid Arteries/diagnostic imaging

KW - Disease Progression

KW - Female

KW - Femoral Artery/diagnostic imaging

KW - Follow-Up Studies

KW - Humans

KW - Imaging, Three-Dimensional

KW - Male

KW - Middle Aged

KW - Plaque, Atherosclerotic/diagnosis

KW - Prospective Studies

KW - Reproducibility of Results

KW - Ultrasonography/methods

U2 - 10.1016/j.jacc.2017.05.033

DO - 10.1016/j.jacc.2017.05.033

M3 - A1: Web of Science-article

C2 - 28705310

SN - 0735-1097

VL - 70

SP - 301

EP - 313

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 3

ER -

Subclinical atherosclerosis burden by 3D ultrasound in mid-life: the PESA study

Abstract

Keywords

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