Subclinical atherosclerosis present in many adults without CV risk factors

I had zero risk factors except my Dad had 80% blockage in one of his carotids. My right carotid is luckily now totally closed up.

Subclinical atherosclerosis present in many adults without CV risk factors

Fernandez-Friera L, et al. J Am Coll Cardiol. 2017;doi:10.1016/j.jacc.2017.10.024.
Nambi V, et al. J Am Coll Cardiol. 2017;doi:10.1016/j.jacc.2017.10.068.

December 12, 2017

Early subclinical atherosclerosis was present in approximately one-half of middle-aged adults who were free from CV risk factors, according to results published in the Journal of the American College of Cardiology.

“Subclinical atherosclerosis underlies most cardiovascular events, and its detection can improve risk stratification,” Leticia Fernández-Friera, MD, PhD, from the Centro Nacional de Investigaciones Cardiovasculares Carlos III in Madrid, and colleagues wrote. “In this study, we aimed to explore and identify potential predictors of the presence and multiterritorial extent of subclinical atherosclerosis in the absence of major CV [risk factors].”

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Atherosclerosis and risk factors

To identify predictors of the presence and severity of subclinical atherosclerosis in the absence of major CV risk factors, the researchers evaluated 4,184 participants from the PESA study.

Fernández-Friera and colleagues defined freedom from CV risk factors as no current smoking and untreated BP less than 140 mm Hg/90 mm Hg, fasting glucose less than 126 mg/dL, total cholesterol less than 240 mg/dL, LDL less than 160 mg/dL and HDL of at least 40 mg/dL.

A subgroup consisting of 740 participants with optimal CV risk factors was defined as having BP < less than 120 mm Hg/80 mm Hg, fasting glucose less than 100 mg/dL, HbA1c less than 5.7% and total cholesterol less than 200 mg/dL.

Ultrasound-detected carotid, iliofemoral and abdominal aortic plaques, coronary artery calcification, serum biomarkers and lifestyle were also evaluated in the study.

Subclinical atherosclerosis was found in 49.7% of participants who were free from CV risk factors. Together with male sex and age, LDL was independently associated with atherosclerosis presence and extent, in both the CV risk factor-free group and the CV risk factor-optimal group (OR for each 10 mg/dL = 1.14-1.18; P < .01 for all). Researchers also found a link between atherosclerosis presence and extent and HbA1c levels in the risk factor-free group.

“Our group identified subclinical atherosclerosis in nearly 60% of middle-aged individuals classified at low risk according to traditional risk scales, with multiple vascular sites affected in 41%,” the researchers wrote. “These findings demonstrate a disparity between conventional CV risk factors and the presence of atherosclerosis, suggesting that other factors play a role in atherogenesis.”

Implications for prevention

In an accompanying editorial, Vijay Nambi, MD, PhD, from the Michael E. DeBakey Veterans Affairs Hospital, Baylor College of Medicine, and Deepak L. Bhatt, MD, MPH, Chief Medical Editor of Cardiology Today's Intervention, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital Heart & Vascular Center and professor of medicine at Harvard Medical School, wrote that the data are an important contribution to the effort to understand primordial prevention and primary prevention of atherosclerotic CVD.

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Lipids as risk factors for stroke and CHD

Secondhand tobacco smoke exposure a risk factor for...

Accelerated atherosclerosis an issue in the AIDS population

“The findings from the current analysis underscore the need to start using advances in imaging, biomarkers and genetics to re-examine the definition of ‘optimal’ cardiovascular health,” they wrote. “Given the significant lead time that atherosclerosis affords us, as a community, it may be time to take a ‘selfie’ of not only our arteries but also our approaches to primordial and primary prevention of [atherosclerotic] CVD.” – by Dave Quaile

Disclosures: Bhatt reports he has financial ties with Amarin, Amgen, AstraZeneca, Biotronik, Boston Scientific, Bristol-Myers Squibb, Cardax, Chiesi, Eisai, Eli Lilly, Ethicon, FlowCo, Forest Laboratories, Ironwood, Ischemix, Medtronic, Merck, Pfizer, PLx Pharma, Regado Biosciences, Roche, Sanofi Aventis, St. Jude Medical, Takeda and The Medicines Company. Fernández-Friera reports no relevant financial disclosures. Nambi reports he has financial ties with Merck and Siemens Diagnostics and holds a provisional patent with Baylor College of Medicine and Roche on biomarkers for prediction of HF. Please see the study for all other authors’ relevant financial disclosures.