Lowering of BP, lipids may help regress subclinical atherosclerosis among some middle-aged individuals

Atherosclerosis, a systemic disease with an early onset, lacks a comprehensive understanding of its temporal dynamics, including progression and regression, especially in subclinical stages. The study found that risk factor control at a younger age helps in preventing atherosclerosis and its progression.

The study results were published in the journal Journal of the American College of Cardiology.

Despite progress in cardiovascular medicine, atherosclerotic CV disease (ASCVD) remains a major global health threat. Detecting subclinical atherosclerosis (SA) early is vital. Understanding the dynamics, determinants, and patterns of atherosclerosis in various vascular territories is limited. The PESA (Progression of Early Subclinical Atherosclerosis) study cohort, also known as PESA-CNIC (National Center of Cardiovascular Investigations)–Santander, has undergone distinctive serial multi-territorial imaging. This study explored the temporal disease dynamics of subclinical atherosclerosis in apparently healthy, middle-aged, asymptomatic individuals using data from baseline and 6-year follow-up 3DVUS imaging examinations.

The PESA (Progression of Early Subclinical Atherosclerosis) cohort study involved 3,471 participants aged 40-55 years, with 36% females, undergoing three serial 3DVUS imaging assessments of peripheral arteries at 3-year intervals. Subclinical atherosclerosis was quantified as global plaque volume (mm3), considering bilateral carotid and femoral plaque burden. Multivariable logistic regression models were developed to analyze factors influencing progression and regression, utilizing stepwise forward variable selection.

Results showed that over the 6-year period, 32.7% of the cohort experienced subclinical atherosclerosis progression, with 17.5% presenting incident disease and 15.2% progressing from prevalent disease at enrollment. Additionally, regression was observed in 8.0% of individuals with baseline disease. Notably, the impact of higher low-density lipoprotein cholesterol (LDL-C) and elevated systolic blood pressure (SBP) on 6-year subclinical atherosclerosis progression risk was more pronounced among participants in the youngest age stratum (P interaction = 0.04 and 0.02, respectively).

In conclusion, this study highlights that subclinical atherosclerosis progresses in one-third of middle-aged asymptomatic subjects over a 6-year period. Moreover, it suggests that atherosclerosis regression is possible in its early stages. The study underscores the influence of LDL-C and SBP on subclinical atherosclerosis progression, with a notable emphasis on the impact being more pronounced in younger participants. This finding implies that enhancing risk factor control, for LDL-C and SBP, in younger individuals could potentially contribute to preventing atherosclerosis and its progression. The long-term impact of such measures could significantly reduce the risk of clinical events associated with atherosclerosis. (Progression of Early Subclinical Atherosclerosis)

Further reading: 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