JACC Focus Seminar: The Best of Population Research Studies
JACC Focus Seminar
Progression of Early Subclinical Atherosclerosis (PESA) Study: JACC Focus Seminar 7/8

https://doi.org/10.1016/j.jacc.2021.05.011Get rights and content
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Highlights

  • PESA is an ongoing longitudinal cohort study integrating serial imaging, biological, and behavioral parameters associated with the progression of subclinical atherosclerosis in a large, middle-aged, asymptomatic population.

  • Comprehensive serial multimodality imaging of multiple vascular territories provides detailed characterization of the extent and regional distribution of early asymptomatic atherosclerosis before and during transition to clinical events.

  • Brain imaging and assessments of cognitive function are assessed in association with CV risk factors and subclinical atherosclerosis.

  • The PESA cohort has provided data supporting guideline recommendations for plaque detection and primary prevention, but because these derive predominantly from Caucasian Spanish participants, caution is necessary in generalizing findings to other populations.

Abstract

Atherosclerosis starts early in life and progresses silently for decades. Considering atherosclerosis as a “systemic disease” invites the use of noninvasive methodologies to detect disease in various regions before symptoms appear. The PESA-(Progression of Early Subclinical Atherosclerosis) CNIC-SANTANDER study is an ongoing prospective cohort study examining imaging, biological, and behavioral parameters associated with the presence and progression of early subclinical atherosclerosis. Between 2010 and 2014, PESA enrolled 4,184 asymptomatic middle-aged participants who undergo serial 3-yearly follow-up examinations including clinical interviews, lifestyle questionnaires, sampling, and noninvasive imaging assessment of multiterritorial subclinical atherosclerosis (carotids, iliofemorals, aorta, and coronaries). PESA tracks the trajectories of atherosclerosis and associated disorders from early stages to the transition to symptomatic phases. A joint venture between the CNIC and the Santander Bank, PESA is expected to run until at least 2029, and its significant contributions to date are presented in this review paper.

Key Words

atherosclerosis
cardiovascular disease
cohort
imaging
population
risk stratification

Abbreviations and Acronyms

18FDG PET
18F-fluorodeoxy-glucose position emission tomography
CACS
coronary artery calcium score
CMR
cardiac magnetic resonance
CNIC
Centro Nacional de Investigaciones Cardiovasculares (Spanish National Center for Cardiovascular Research)
CT
computed tomography
CVD
cardiovascular disease
CVRF
cardiovascular risk factor
EN
elastic net
FBS
Fuster BEWAT score
ICHS
ideal cardiovascular health score
LDL-C
low-density lipoprotein cholesterol
LTL
leukocyte telomere length
MetS
metabolic syndrome
MR
magnetic resonance
oxLDL
oxidized low-density lipoprotein
VPA
vigorous physical activity

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Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.

Alan Morrison, MD, PhD, served as Guest Associate Editor for this paper. Athena Poppas, MD, served as Guest Editor-in-Chief for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.

Drs Ibanez and Fernández-Ortiz contributed equally to this work.