Researchers here show that many people in their 40s have measurable signs of preclinical atherosclerosis, the early stages of the development of fatty lesions that narrow and weaken blood vessels. The data shows that these early lesions also progress more rapidly than was expected at this time of life. In its later stages, atherosclerosis results in stroke or heart attack as important vessels rupture or are blocked by debris from a fragmented lesion. At present there is little that can be done to meaningfully reverse existing lesions: lowering blood cholesterol levels only slows progression somewhat. Despite considerable interest in the research community in achieving reversal of established lesions, there has been little practical progress towards viable therapies in recent decades.

The PESA ('Progression of early subclinical atherosclerosis') study has been monitoring 4200 healthy middle-aged men and women with noninvasive imaging technology and omics biomarkers for more than 10 years. The use of noninvasive imaging technologies "allows us to identify the progression of the disease earlier than is possible with classical markers, such as the presence of coronary calcium detected by computed tomography (CT), thus allowing us to identify individuals at higher risk who could benefit from early intervention. The results show that ultrasound of the peripheral arteries is a more efficient method for detecting atherosclerosis progression than the study of coronary calcium by CT."

Atherosclerosis is characterized by the accumulation of fatty deposits in the artery walls. The disease is normally detected at an advanced stage, when it has already caused clinical events such as a heart attack or stroke. Treatment of the disease at this symptomatic stage is of limited effectiveness, and most patients experience a decline in quality of life. The treatment of these patients, moreover, places a significant burden on health care resources.

"This study is the first to analyze the progression of atherosclerosis at frequent intervals. The previous view was that the disease progressed very slowly throughout life. However, the new results show that the disease progressed very rapidly in 40% of the individuals analyzed. Future data from the PESA study will show whether this progression is associated with subsequent cardiovascular events. Until now, the speed of atherosclerosis progression has not been a factor in assessing individual risk."

"The key finding of the study is that over a short follow-up of just 3 years, 40% of individuals aged between 40 and 50 years showed major progression of atherosclerosis in distinct locations, including the carotid, femoral, and coronary arteries. This rapid disease progression could make these individuals more vulnerable to developing symptoms or having clinical events such as a heart attack or stroke." The researchers conclude that the findings, while they await validation from the occurrence of events in the PESA cohort in the future, will be of great value for the identification of strategies to stall the epidemic of cardiovascular disease.