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

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

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Ankle Brachial Index
  • Aorta, Abdominal / diagnostic imaging
  • Aorta, Abdominal / pathology
  • Aortic Diseases / diagnostic imaging
  • Aortic Diseases / epidemiology*
  • Aortic Diseases / pathology
  • Aortography
  • Asymptomatic Diseases
  • Atherosclerosis / diagnostic imaging
  • Atherosclerosis / epidemiology*
  • Atherosclerosis / pathology
  • Calcinosis / diagnostic imaging
  • Calcinosis / epidemiology
  • Calcinosis / pathology
  • Carotid Artery Diseases / diagnostic imaging
  • Carotid Artery Diseases / epidemiology
  • Carotid Artery Diseases / pathology
  • Comorbidity
  • Coronary Angiography
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / epidemiology
  • Coronary Artery Disease / pathology
  • Disease Progression
  • Female
  • Femoral Artery / diagnostic imaging
  • Femoral Artery / pathology
  • Follow-Up Studies
  • Humans
  • Iliac Artery / diagnostic imaging
  • Iliac Artery / pathology
  • Male
  • Middle Aged
  • Multidetector Computed Tomography
  • Plaque, Atherosclerotic / diagnostic imaging
  • Plaque, Atherosclerotic / epidemiology
  • Prevalence
  • Prospective Studies
  • Risk Factors
  • Spain / epidemiology
  • Ultrasonography

Associated data

  • ClinicalTrials.gov/NCT01410318