Prevalence, Vascular Distribution, and Multiterritorial Extent of Subclinical Atherosclerosis in a Middle-Aged Cohort The PESA (Progression of Early Subclinical Atherosclerosis) Study
Prevalence, Vascular Distribution, and Multiterritorial Extent of Subclinical Atherosclerosis in a Middle-Aged Cohort The PESA (Progression of Early Subclinical Atherosclerosis) Study
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DOI：
10.1161/circulationaha.114.014310
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发表时间：
2015-06-16
期刊：
影响因子：
37.8
通讯作者：
Fuster, Valentin
中科院分区：
文献类型：
--
作者：
Fernandez-Friera, Leticia;Penalvo, Jose L.;Fuster, Valentin
背景：亚临床动脉粥样硬化在中年人群中的存在、分布和程度数据有限。方法和结果：PESA（早期亚临床动脉粥样硬化进展）研究前瞻性纳入4184名无症状参与者，年龄在40至54岁之间（平均年龄45.8岁，63%为男性），通过二维/三维超声和计算机断层扫描评估颈动脉、腹主动脉和髂股动脉区域动脉粥样硬化的全身程度。亚临床动脉粥样硬化的程度，定义为存在斑块或冠状动脉钙化>= 1，在检查每个血管部位（右/左颈动脉、主动脉、右/左髂股动脉和冠状动脉）后，分为局灶性（1个部位受影响）、中度（2-3个部位）或广泛性（4-6个部位）。63%的参与者存在亚临床动脉粥样硬化（71%的男性，48%的女性）。41%为中度和广泛性动脉粥样硬化。斑块最常见于髂股动脉（44%），其次是颈动脉（31%）和主动脉（25%），而冠状动脉钙化发生率为18%。在弗雷明汉心脏研究（FHS）低10年风险的参与者中，58%的人检测到亚临床疾病，36%的人检测到中度或全身性疾病。当评估长期风险（30年FHS）时，83%的高风险参与者患有动脉粥样硬化，其中66%被归类为中度或一般。结论：亚临床动脉粥样硬化在中年队列中非常普遍，近一半的参与者被归类为中度或全身性疾病。FHS高危人群多为亚临床疾病；然而，大量低风险个体也存在广泛的动脉粥样硬化，这表明影像学在诊断和预防方面具有附加价值。
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.