Progression and Regression of Subclinical Atherosclerosis

A Spanish longitudinal cohort study suggested that the impact of low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure (SBP) on subclinical atherosclerosis (SA) progression might be more pronounced in younger participants. SA was quantified as global plaque volume (bilateral carotid and femoral plaque burden) in 3,471 asymptomatic participants (baseline age 40-55 years; 36% female). Over 6 years, SA progression occurred in 32.7% of the cohort (17.5% with incident SA and 15.2% progressing from baseline). Regression was observed in 8.0% of those with baseline SA. The effects of high LDL-C and elevated SBP on 6-year SA progression risk were more pronounced among participants in the youngest age stratum. Baseline active smoking, male sex, high fibrinogen, high LDL-C, and old age are strong predictors of SA progression, but inversely related to SA regression. The findings suggest that the prevention of SA and its progression could be enhanced by tighter risk factor control at younger ages. SA frequently begins early in life. Plaque evolution in the early SA stages seems to be highly dynamic and possibly more susceptible to interventions, although the effect of plaque volume changes on the risk of future events remains to be determined. Source: https://www.jacc.org/