Subclinical Atherosclerosis: PESA Cohort Study Redefines Prevention
Atherosclerosis May Not Be a One-Way Street: Early Intervention Key to Slowing Plaque Buildup.
DR T S DIDWAL MD
1/16/20245 min read
Early undetected atherosclerosis (plaque buildup) progressed in over a third of middle-aged adults over 6 years, especially those with high LDL-C or blood pressure. Surprisingly, some small early plaques even reversed. Tight control of these risk factors, particularly in younger people, may significantly prevent future heart disease. 3D ultrasound of the arteries may help identify vulnerable individuals for personalized prevention strategies. The Progression of Early Subclinical Atherosclerosis (PESA) study,published in the Journal of the American College of Cardiology, challenges the traditional view of atherosclerosis as solely progressive, offering hope for potential remission and highlighting the importance of early intervention.
Main findings:
Atherosclerosis progression (plaque buildup) occurred in 32.7% of middle-aged, asymptomatic individuals over 6 years.
Regression (plaque decrease) was observed in 8.0% of those with initial plaque.
Higher LDL-C and elevated systolic blood pressure (SBP) strongly predict progression, especially in younger individuals.
Active smoking negatively impacts both progression and regression.
Regression is more likely in individuals with smaller plaque burdens at baseline.
Insights into disease dynamics:
Atherosclerosis frequently starts early and progresses faster with childhood risk factor exposure.
Tighter CVRF control, especially LDL-C and SBP, during young adulthood could significantly impact disease progression and potentially reduce future ASCVD risk.
Plaque in the early stages might be more susceptible to interventions, highlighting the importance of early screening and prevention.
Methodological details:
Studied 3,471 asymptomatic individuals aged 40–55 using multi-territorial 3D vascular ultrasound (3DVUS) imaging of peripheral arteries.
Tracked plaque volume changes over 3 serial 6-year intervals.
Multivariable regression models identified independent predictors of progression and regression.
Limitations:
Self-reported data (age, lifestyle habits) might be inaccurate.
Limited assessment of screen-based sitting, known to impact health.
Changes in behavior since baseline (2002) could affect results.
Limited follow-up waves could potentially miss details of disease dynamics.
Self-reported depression diagnoses might only capture severe cases.
Clinical implications:
CVRF control should be prioritized early in life to prevent atherosclerosis progression and future ASCVD events.
3DVUS might be a valuable tool for assessing individual vulnerability and implementing personalized preventive strategies.
The possibility of atherosclerosis remission in the early stages suggests the potential for effective interventions.
A mindset shift is needed, from viewing atherosclerosis as solely progressive to recognizing its potential for regression and focusing on early prevention.
Overall, this study provides valuable insights into the temporal dynamics of subclinical atherosclerosis, highlighting the importance of early CVRF control and offering promising perspectives for future preventive strategies and public health recommendations.
In the landscape of cardiovascular medicine, atherosclerotic cardiovascular disease (ASCVD) continues to exert its influence as a predominant cause of morbidity and mortality globally. While advancements in the field have been noteworthy, delving into the intricacies of atherosclerosis, especially during its subclinical phase, remains a significant challenge. This article aims to dissect the groundbreaking findings of the Progression of Early Subclinical Atherosclerosis (PESA) study, published in the Journal of the American College of Cardiology, challenging conventional perspectives and offering a paradigm shift in our understanding of atherosclerosis.
Unraveling the PESA Cohort Study
The PESA cohort study, a beacon of knowledge in cardiovascular research, focused on middle-aged, asymptomatic individuals aged 40–55. Employing cutting-edge multi-territorial 3-dimensional vascular ultrasound (3DVUS) imaging, the study meticulously tracked plaque volume changes over three serial 6-year intervals. This innovative approach allowed for a comprehensive evaluation of subclinical atherosclerosis in peripheral arteries, transcending the limitations of traditional assessments.
Key Findings: A Closer Look at the Numbers
Over the 6-year span, the study revealed that 32.7% of middle-aged, asymptomatic individuals experienced progression in subclinical atherosclerosis. Contrary to conventional belief, regression was observed in 8.0% of those with initial plaque, providing a glimmer of hope and challenging the notion of atherosclerosis as solely progressive.
Predictors of Progression and Regression
The study identified key predictors influencing the progression and regression of subclinical atherosclerosis. Higher levels of low-density lipoprotein cholesterol (LDL-C) and elevated systolic blood pressure (SBP) emerged as strong indicators of progression, particularly impactful in younger individuals. Active smoking, a well-known cardiovascular risk factor, exhibited a negative impact on both progression and regression.
Insights into Disease Dynamics
Atherosclerosis, often considered a disease of aging, frequently begins early in life. Childhood exposure to risk factors accelerates its progression, emphasizing the importance of early intervention. The study underscores the need for tighter control of cardiovascular risk factors, especially LDL-C and SBP, during young adulthood to significantly impact disease progression and potentially reduce future ASCVD risk.
Methodological Details: Unveiling Precision in Research
To achieve these groundbreaking findings, the PESA study meticulously examined 3,471 asymptomatic individuals, utilizing multi-territorial 3DVUS imaging of peripheral arteries. The tracking of plaque volume changes over three serial 6-year intervals provided a robust foundation for the identification of independent predictors of both progression and regression.
Limitations and Considerations
While the study offers invaluable insights, it is crucial to acknowledge its limitations. Self-reported data, including age and lifestyle habits, may introduce inaccuracies. The limited assessment of screen-based sitting, a known health impactor, and potential changes in behavior since the baseline year of 2002 may influence results. Additionally, the study's follow-up waves might miss nuanced details of disease dynamics.
Clinical Implications: Shaping the Future of Preventive Cardiology
The implications of the PESA cohort study are profound, urging a transformative shift in the approach to atherosclerosis. Cardiovascular risk factor (CVRF) control emerges as a pivotal strategy, with a call to prioritize it early in life to prevent atherosclerosis progression and future ASCVD events.
The Role of 3D Ultrasound in Personalized Prevention
The study advocates for the integration of 3DVUS as a valuable tool in assessing individual vulnerability. This non-invasive, radiation-free technique provides a detailed view of peripheral arteries, aiding in the implementation of personalized preventive strategies.
Atherosclerosis Remission: A New Perspective
Contrary to the prevailing belief that atherosclerosis is an irreversible, progressive disease, the PESA study introduces the concept of remission. The early stages of plaque development may prove more susceptible to interventions, emphasizing the critical importance of early screening and prevention.
Conclusion: Shifting Perspectives for a Healthier Future
In conclusion, the PESA cohort study unveils unprecedented insights into the temporal dynamics of subclinical atherosclerosis. By challenging the traditional narrative and offering a more nuanced understanding, the study calls for a paradigm shift—from viewing atherosclerosis solely as a progressive force to recognizing its potential for regression. The findings underscore the urgency of initiating preventive measures early in life, presenting a tangible path towards atherosclerosis remission.
Reference Article
Mendieta, G, Pocock, S, Mass, V. et al. Determinants of Progression and Regression of Subclinical Atherosclerosis Over 6 Years. J Am Coll Cardiol. 2023 Nov, 82 (22) 2069–2083. https://doi.org/10.1016/j.jacc.2023.09.814
Image Credit: Wikimedia Commons
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https://healthnewstrend.com/aging-and-your-heart-understanding-cardiovascular-changes-over-time
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