The health problem that causes the most deaths in the world, arteriosclerosis, usually begins in youth and is reversible in its initial phases, according to a macro study carried out in Spain that changes the scientific paradigm of the disease. According to the new vision, early detection of arteriosclerosis in the general population should begin before the age of 40. In cases where it is detected that cholesterol has begun to accumulate in the arteries, it would be advisable to take measures to reduce it.
“It is the future we are going towards,” declares cardiologist Valentín Fuster, medical director of the Mount Sinai hospital in New York and general director of the National Center for Cardiovascular Research (CNIC) in Madrid, which has designed and directed the research project. “We now know that the disease begins long before symptoms appear. If we act in the initial phases, we will be able to prevent strokes and heart attacks decades later.”
To understand when and how the deterioration of the arteries that leads to cardiovascular accidents begins, Fuster launched the PESA study (Progression of Early Subclinical Atherosclerosis) in 2010. More than 4,000 employees of Banco Santander in Spain participate in it, two thirds of whom are men, who were between 40 and 54 years old when they enrolled in the study and who did not have any diagnosed health problems.
An ultrasound of the femoral arteries, carotid arteries and aorta was performed and it was discovered that 71% of the men and 48% of the women already had abnormal cholesterol accumulations. The ultrasounds have been repeated every three years to see how the condition of the arteries evolves in this long period in which arteriosclerosis still does not cause symptoms.
According to the latest results of the PESA study, published on November 28 in the JACC magazine, after six years atherosclerosis has progressed in 33% of the study participants. But, unexpectedly, there are 8% of the participants in whom the disease has remitted.
The regression of arteriosclerosis is more likely in women, in younger age groups and in people who had a low LDL cholesterol level to begin with. On the contrary, smokers and/or people with hypertension are those who are most likely to have the disease progress.
“The PESA study questions our conventional prevention strategy and underscores the need for early detection and robust modification of risk factors to stop atherosclerosis in its tracks,” Charles German and Michael Shapiro of the universities write in an analysis article in JACC. from Chicago and Wake Forest, respectively. “Can we wait ten or twenty years [to act] when arteriosclerosis has been detected?”
According to German and Shapiro, “instead of limiting ourselves to preventing cardiovascular accidents, we can move to reversing and curing this devastating disease; It is time to change the paradigm.”
To reverse and cure arteriosclerosis, it will be necessary to diagnose it early, before it causes symptoms. “Until now it was not possible because we did not have the technology to see that the arteries were beginning to alter. But with new ultrasound techniques of the arteries, which are inexpensive, we will be able to detect subclinical arteriosclerosis in young people,” declares Valentín Fuster.
In cases where it is detected that the process of deterioration of the arteries has begun, treatments for cholesterol, hypertension and/or prediabetes may be prescribed, depending on the health parameters of each person. If another ultrasound of the arteries shows that atherosclerosis has remitted a few years later, it will be possible to consider whether to discontinue the medication.
This prevention strategy raises questions that still have no answers. At what age should the first early detection test for arteriosclerosis be done? How often should it be repeated? Will young people who do not yet have symptoms and feel perfectly fine be willing to take medication? What treatments would be most appropriate for this population? How would it improve your quality of life?
To begin to answer these questions, Fuster has started the PRECAD study in which 2,000 people between 20 and 39 years old from New York without diagnosed health problems will participate. If they are found to have cholesterol buildup in their arteries and have an LDL cholesterol level of more than 70, they will be offered cholesterol-lowering medication. “We hope to have the first results within five years,” says Fuster. “Then the study will continue until reaching twenty years to analyze the effects of this long-term prevention strategy,” says Fuster.
