PESA, CNIC - Santander

Progression of Early Subclinical Atherosclerosis, CNIC - Santander

Strategies to identify individuals with subclinical alterations indicating increased risk of cardiovascular disease have been boosted by the recent development of advanced non-invasive imaging techniques (magnetic resonance imaging, positron emission tomography, and computerized tomography) that can be applied to large populations. Several studies currently underway, such as the High-Risk Population (HRP) study, led by Valentín Fuster in the USA, are pioneering the application of these techniques to population studies. However, most studies to date have examined populations over the age of 60. Atherosclerotic disease in this group has already had several decades of evolution and may not be fully reversible. To assess the early onset of atherosclerosis, longitudinal vascular imaging studies are needed to provide information about middle-aged populations.

PESA is a longitudinal study, run in partnership with Banco Santander and the Botín Foundation, into the use of imaging techniques to detect the prevalence and rate of progression of subclinical vascular lesions in a population of 4500 male and female workers aged between 40 and 54 years. The study examines the association of these clinical parameters with the presence of genetic, epigenetic, metabolomic, proteomic and environmental factors, including dietary habits, physical activity, biorhythms, psychosocial characteristics and exposure to environmental pollutants.

The PESA CNIC-Santander study will help to identify risk factors and daily habits that influence the development of atherosclerosis, and will improve the prevention of atherosclerotic disease by achieving early diagnose before the appearance of symptoms.

Participants are first assessed with basic imaging techniques, including CT imaging to estimate coronary calcium, 3D ultrasound of carotid artery, and 2D ultrasound measurement of abdominal aorta and the rate of ankle-brachial pressure. These techniques are used for the early diagnosis of individuals with subclinical atherosclerosis. Participants are then studied with two advanced imaging techniques: magnetic resonance imaging (MRI) and positron emission tomography (PET). These advanced techniques will help determine participants' atherosclerotic burden and monitor its progression and the presence and progression of inflammation in atherosclerotic plaques.

The study will also provide important information about the prevalence of unrecognized myocardial infarction in this population, and will assess the prevalence and progression of subclinical atherosclerosis in women during peri-menopause and its relation to cardiovascular risk factors and hormonal changes.