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Subclinical atheromatosis localization and burden in a low-to-moderate cardiovascular risk population: the ILERVAS
Marcelino Bermúdez-López1, Montse Martínez-Alonso2, Eva Castro-Boqué1
1Grupo Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain.
Insights
Subclinical atheromatosis is highly prevalent in middle-aged individuals with low-to-moderate cardiovascular risk. Nearly 20% of participants showed generalized atheromatosis, indicating a significant subclinical disease burden.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Preventive Cardiology
Background:
- Cardiovascular risk factors (CVRF) assessment may underestimate subclinical disease burden.
- Atheromatosis, kidney disease, prediabetes, and diabetes are common chronic conditions.
- Understanding subclinical disease prevalence is crucial for risk stratification.
Purpose of the Study:
- To determine the prevalence of subclinical diseases (atheromatosis, kidney disease, diabetes) in a middle-aged population with low-to-moderate cardiovascular risk.
- To evaluate the vascular distribution and severity of subclinical atheromatosis.
- To identify discrepancies between CVRF and actual atheromatosis burden.
Main Methods:
- A randomized, interventional, longitudinal clinical trial involving 8330 asymptomatic participants.
- Vascular ultrasound of carotid and femoral arteries across 12 territories.
- Assessment of clinical, anthropometric, lifestyle, and biochemical parameters.
Main Results:
- Subclinical atheromatosis found in 71.4% of participants, common in femoral and carotid arteries.
- 1 in 5 participants (19.7%) had generalized atheromatosis (>3 territories).
- Previously undiagnosed chronic diseases included dyslipidemia (21.1%), hypertension (15.3%), and kidney disease (15.4%).
Conclusions:
- Subclinical atheromatosis is highly prevalent in middle-aged individuals with low-to-moderate cardiovascular risk.
- A significant proportion of individuals have generalized atheromatosis, suggesting underestimation of cardiovascular risk.
- Early detection and intervention for subclinical diseases are warranted.
Introduction And Objectives:
There is a discrepancy between risk assessment based on cardiovascular risk factors (CVRF) and atheromatosis burden. The objective was to identify the prevalence of subclinical diseases with common risk factors, such as atheromatosis, occult kidney disease, prediabetes, and diabetes in a middle-aged population with low-to-moderate cardiovascular risk; to assess the vascular distribution, and severity of subclinical atheromatosis.
Methods:
Randomized, interventional, longitudinal clinical trial. The intervention consisted of vascular ultrasound examination in the carotid and femoral arteries assessing 12 territories, combined with clinical, anthropometric, lifestyle, and biochemical parameters. Inclusion criteria consisted of women (aged 50-70 years) and men (aged 45-65 years) with at least 1 CVRF. Exclusion criteria consisted of a clinical history of diabetes, chronic kidney disease, or a prior CV event. Here, baseline characteristics of the ILERVAS cohort are shown.
Results:
A total of 8330 middle-aged asymptomatic participants, 50.7% women, were enrolled. The presence of 1-2 CVRF was found in 74.8% and adherence to the Mediterranean diet was low in 52.8%. Several previously unknown chronic diseases were diagnosed, such as dyslipidemia (21.1%), hypertension (15.3%), kidney disease (15.4%), obesity (10.6%), and diabetes (2.3%). Subclinical atheromatosis was found in 71.4% of participants, localized in common femoral (54.5%), carotid bifurcation (41.1%) and internal carotid (22%). Intermediate atheromatosis (2-3 territories with atheroma plaque) was found in 32.6%, and generalized atheromatosis (>3 territories) in 19.7. Total plaque area was higher in men (0.97 cm2 vs 0.58 cm2, P<.001). Total plaque area was also higher in the femoral artery, and increased with the number of CVRF.
Conclusions:
Subclinical atheromatosis was highly prevalent in a middle-aged population with low-to moderate cardiovascular risk, with 1 in 5 participants having generalized atheromatosis. ClinicalTrials.gov Identifier: NCT03228459.
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