Predicting Subclinical Atherosclerosis in Low-Risk Individuals

Study Questions:

How do the ideal cardiovascular health score (ICHS) and Fuster-BEWAT (blood pressure [B], exercise [E], weight [W], alimentation [A], and tobacco [T]) score (FBS) compare for predicting the presence and extent of subclinical atherosclerosis?


A total of 3,983 individuals aged 40-54 years, enrolled in the PESA (Progression of Early Subclinical Atherosclerosis) cohort, were studied. Subclinical atherosclerosis was measured in right and left carotids, abdominal aorta, right and left iliofemoral by ultrasound, and coronary arteries with the coronary artery calcium score (CACS). All subjects underwent cholesterol and fasting blood sugar level. Subjects were classified as having poor, intermediate, or ideal cardiovascular health based on the number of favorable ICHS which includes cholesterol and fasting blood glucose, or FBS metrics which do not.


Mean age was 45.8 (4.3) years and 63% were men. With poor ICHS/FBS as reference, individuals with ideal ICHS/FBS showed lower adjusted odds of having atherosclerotic plaques (odds ratio [OR], 0.41/OR, 0.49), coronary artery calcium score (CACS) ≥1 (OR, 0.41/OR, 0.53), higher number of affected territories (OR, 0.32/OR, 0.39), and higher CACS level (OR, 0.40/OR, 0.52). Similar significant discriminating accuracy was found for ICHS and FBS with respect to the presence of plaques (c-statistic, 0.694; 95% confidence interval [CI], 0.678-0.711 vs. 0.692; 95% CI, 0.676-0.709) and for CACS ≥1 (c-statistic, 0.782; 95% CI, 0.765-0.800 vs. 0.780; 95% CI, 0.762-0.798).


Both scores predict with similar accuracy the presence and extent of subclinical atherosclerosis, highlighting the value of the FBS as a more simple and affordable score for evaluating the risk of subclinical disease.


This young cohort was low risk, with a mean 10-year Framingham risk score (FRS) of 5.8% (4.3), and 30-year FRS of 17.5% (11.7). Among the important future observations from the PESA observational study will be the predictive value of coronary events and strokes using multiple-site expensive subclinical atherosclerosis detection versus a relatively cheap and highly reproducible CACS with cholesterol and glucose.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Noninvasive Imaging, Prevention, Lipid Metabolism, Nonstatins, Computed Tomography, Echocardiography/Ultrasound, Nuclear Imaging, Diet, Exercise, Smoking

Keywords: Atherosclerosis, Blood Glucose, Blood Pressure, Cholesterol, Diagnostic Imaging, Exercise, Fasting, Glucose, Plaque, Atherosclerotic, Primary Prevention, Risk, Stroke, Smoking, Tomography, X-Ray Computed, Ultrasonography

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