Prevalence, Vascular Distribution and Multi-territorial Extent of Subclinical Atherosclerosis in a Middle-Aged Cohort: The PESA (Progression of Early Subclinical Atherosclerosis) Study
Background—Data are limited regarding 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 aged 40-54 years (mean age 45.8 years, 63% male) to evaluate the systemic extent of atherosclerosis in the carotid, abdominal aortic and ilio-femoral territories by 2D/3D ultrasound and coronary artery calcification (CAC) by computed tomography. The extent of subclinical atherosclerosis, defined as presence of plaque or CAC≥1, was classified as focal (one site affected), intermediate (2-3 sites) or generalized (4-6 sites) after exploring each vascular site (right/left carotids, aorta, right/left ilio-femorals 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 ilio-femorals (44%), followed by carotids (31%) and aorta (25%), while CAC 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 assessing longer-term risk (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 the participants classified as having intermediate or generalized disease. Most participants at high FHS risk had subclinical disease; nonetheless, 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 Information—ClinicalTrials.gov. Identifier: NCT01410318.
- Received November 14, 2014.
- Revision received April 4, 2015.
- Accepted April 10, 2015.