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Publications

Journal Article Ahead of print 5 citations

PubMed: 42670946 DOI: 10.1056/NEJMoa2609059

Prevalence of Silent Atherosclerosis across Adult Life.

N Engl J Med

Authors: Henning Bundgaard, Inés García-Lunar, Klaus F Kofoed, Rasmus Hasselbalch, Carlos Nicolás Pérez-García, Joakim Bo Kunkel, Frederik Filip Stæger, Fátima Sánchez-Cabo, José J Fuster, Virginia Mass, Javier Sánchez-González, Maja V Kragh, Anna K Ringgaard, Javier Valls-Monzó, Michael Huy Cuong Pham, Ana Devesa, Morten Sejer, Per Sigvardsen, Antonio Quesada, Charlotte Eberhard, Ana García-Álvarez, Lea Marie Pehrson, Álvaro Navarro-Guzmán, Simon Winther, Mathias Sørgaard, Marcos Gámez, Martin Lundsgaard, Cristina Pérez-Herreras, Ruth Frikke-Schmidt, Pedro L Sánchez, Nikolaj Eldrup, Juan Torres-Macho, Morten Bøttcher, Valentin Fuster, Kasper K Iversen, Borja Ibanez

Affiliations

  • Department of Cardiology, the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen.
  • Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen.
  • Centro Nacional de Investigaciones Cardiovasculares, Madrid.
  • University Hospital La Moraleja, Madrid.
  • Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid.
  • Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen.
  • Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen.
  • Philips Healthcare, Madrid.
  • Universidad Autónoma de Madrid, Madrid.
  • Cardiology Department, Hospital Universitario La Luz, Madrid.
  • Department of Cardiology, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona.
  • Department of Cardiology, Gødstrup Hospital, Herning, Denmark.
  • Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
  • Department of Cardiology, Copenhagen University Hospital, Herlev og Gentofte, Copenhagen.
  • Healthcare Department, Bank of Santander, Madrid.
  • Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen.
  • Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain.
  • Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen.
  • Department of Internal Medicine, Hospital Universitario Infanta Leonor, Complutense University, Madrid.
  • Mount Sinai Fuster Heart Hospital, New York.
  • Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid.

Abstract

BACKGROUND

Atherosclerosis may begin in early adulthood and remain clinically silent for decades before cardiovascular disease manifests. Although silent atherosclerosis is associated with cardiovascular events and death independent of traditional cardiovascular disease risk factors, its age- and sex-specific prevalence, vascular territory distribution, and plaque volume across adult life remain incompletely defined.

METHODS

We conducted a prospective cohort study in Denmark and Spain. Adults 18 to 70 years of age without known atherosclerotic cardiovascular disease were enrolled in five prespecified age strata that included balanced numbers of women and men. Silent atherosclerosis was assessed at baseline with three-dimensional vascular ultrasonography of the carotid and femoral arteries and with coronary computed tomographic angiography.

RESULTS

A total of 16,808 adults were enrolled in the study. The mean (±SD) age of the participants was 45±12 years, and 51.4% were women. Silent atherosclerosis was present in 57.1% of the participants (95% confidence interval, 56.3 to 58.0). In the youngest age stratum (18 to 29 years), atherosclerosis was present in 8.7% of the men and 6.7% of the women; prevalence increased with age, with a later, steeper midlife rise among women. Among participants in the younger age strata, atherosclerosis was most often peripheral and confined to a single vascular territory; with increasing age, plaque volume increased exponentially and the prevalence of multiarterial involvement became more frequent. Isolated coronary-artery atherosclerosis was uncommon in every age stratum (≤9.3% of men and ≤5.0% of women).

CONCLUSIONS

This study of silent atherosclerosis showed that the disease was detectable in early adulthood, with age- and sex-associated increases in prevalence across arterial territories and marked increases in plaque volume. (Funded by the Novo Nordisk Foundation; REACT ClinicalTrials.gov number, NCT06692127.).

MeSH

Cardiovascular Diseases, Arteries, Prevalence, Sex, Atherosclerosis