Author + information
- Received November 16, 2019
- Revision received December 27, 2019
- Accepted February 4, 2020
- Published online April 6, 2020.
- Beatriz López-Melgar, MD, PhDa,b,
- Leticia Fernández-Friera, MD, PhDa,b,c,
- Belén Oliva, MSca,
- José Manuel García-Ruiz, MDa,c,d,
- Fátima Sánchez-Cabo, PhDa,
- Héctor Bueno, MD, PhDa,c,e,
- José María Mendiguren, MDf,
- Enrique Lara-Pezzi, PhDa,c,
- Vicente Andrés, PhDa,c,
- Borja Ibáñez, MD, PhDa,c,g,
- Antonio Fernández-Ortiz, MD, PhDa,c,h,
- Javier Sanz, MDa,i,∗∗ ( )( and )
- Valentín Fuster, MD, PhDa,i,∗ ( )()
- aCentro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- bHM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Madrid, Spain
- cCIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- dInstituto de Investigación Sanitaria del Principado de Asturias, Hospital Universitario de Cabueñes, Gijón, Spain
- eHospital Universitario 12 de Octubre, Madrid, Spain
- fBanco de Santander, Madrid, Spain
- gIIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
- hHospital Clínico San Carlos IdISSC, Madrid, Spain
- iThe Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, New York
Background Atherosclerosis progression predicts cardiovascular events; however, progression of multiterritorial subclinical atherosclerosis is incompletely understood.
Objectives This study sought to study short-term progression of atherosclerosis using different noninvasive imaging techniques and their relationship with cardiovascular risk.
Methods The study included 3,514 PESA (Progression of Early Subclinical Atherosclerosis) study participants (45.7 ± 4.2 years of age; 63% men). Participants underwent 2-dimensional vascular ultrasound (2DVUS) of abdominal aorta, carotid, iliac, and femoral territories to determine a plaque number score; 3DVUS to quantify carotid and femoral plaque volume; and coronary artery calcium score (CACS) at baseline and 2.8 years later. The authors calculated the rate of new disease incidence and changes in disease extent. Logistic regression models were used to evaluate associations of progression rates with baseline cardiovascular risk factors and estimated 10-year risk.
Results Imaging detected short-term (3-year) atherosclerosis progression in 41.5% of participants (26.4% by 2DVUS, 21.3% by 3DVUS, and 11.5% by CACS), particularly in peripheral territories examined by vascular ultrasound. New atherosclerosis onset accounted for approximately one-third of total progression, also more frequently by 2DVUS and 3DVUS (29.1% and 16.6%, respectively), than by CACS (2.9%). Participants with baseline disease by all 3 modalities (n = 432) also showed significant atherosclerosis progression (median: 1 plaque [interquartile range (IQR): −1 to 3 plaques] by 2DVUS; 7.6 mm3 [IQR: −32.2 to 57.6 mm3] by 3DVUS; and 21.6 Agatston units [IQR: 4.8 to 62.6 Agatston units] by CACS). Age, sex, dyslipidemia, hypertension, smoking, and family history of premature cardiovascular disease contributed to progression, with dyslipidemia the strongest modifiable risk factor. Although disease progression correlated with cardiovascular risk, progression was detected in 36.5% of participants categorized as low risk.
Conclusions With this multimodal and multiterritorial approach, the authors detected short-term progression of early subclinical atherosclerosis in a substantial proportion (41.5%) of apparently healthy middle-aged men and women, more frequently by peripheral 2D/3DVUS than by CACS. Disease progression, as defined in this study, correlated with almost all cardiovascular risk factors and estimated risk. (Progression of Early Subclinical Atherosclerosis [PESA]; NCT01410318)
- cardiovascular risk
- cardiovascular risk factors
- coronary and noncoronary atherosclerosis progression
- multiterritory noninvasive imaging
- short-term atherosclerosis progression
The PESA-CNIC-Santander study is funded by the Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain, and Banco Santander, Madrid, Spain. The study also receives funding from the Instituto de Salud Carlos III (ISC III) (PI15/02019) and the European Regional Development Fund (ERDF) “Una manera de hacer Europa.” The CNIC is supported by the Ministerio de Ciencia e Innovación, the ISC III and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015-0505). Dr. Bueno has received research funding from the Instituto de Salud Carlos III, Spain (PIE16/00021 & PI17/01799); has received research funding from AstraZeneca, Bristol-Myers Squibb, and Novartis; has received consulting fees from AstraZeneca, Bayer, Bristol-Myers Squibb–Pfizer, and Novartis; and has received speaker fees or support for attending scientific meetings from Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb–Pfizer, Novartis, and MEDSCAPE–the heart.org. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. P.K. Shah, MD, served as Guest Editor-in-Chief for this paper.
- Received November 16, 2019.
- Revision received December 27, 2019.
- Accepted February 4, 2020.
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