Progression of Early Subclinical Atherosclerosis (PESA) Study

• Published in: Journal of the American College of Cardiology 2021-07, Vol.78 (2), p.156-179
• Main Authors: Ibanez, Borja, Fernández-Ortiz, Antonio, Fernández-Friera, Leticia, García-Lunar, Inés, Andrés, Vicente, Fuster, Valentín
• Format: Article
• Language: English
• Subjects: atherosclerosis; cardiovascular disease; cohort; imaging; population; risk stratification
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2021.05.011

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. [Display omitted] •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.