Progression of Early Subclinical Atherosclerosis (PESA) Study p JACC Focus Seminar 7/8

cause of mortality and morbidity worldwide and represents the highest proportion of costs to health care systems (1,2). Global CVD prevalence is growing, and if this trend continues, it will threaten the ability of health care systems to cope with its consequences (3). Most forms of CVD originate in atherosclerosis, which is thus the main driver of this terrible scenario. One of the major challenges to addressing this health care crisis is that atheroscle Atherosclerosis starts early in life and progresses silently for decades. Considering atherosclerosis as a "systemic disease" invites the use of noninvasive methodologies to detect disease in various regions before symptoms appear. The PESA(Progression of Early Subclinical Atherosclerosis) CNIC-SANTANDER study is an ongoing prospective cohort study examining imaging, biological, and behavioral parameters associated with the presence and progression of early subclinical atherosclerosis. Between 2010 and 2014, PESA enrolled 4,184 asymptomatic middle-aged participants who undergo serial 3-yearly follow-up examinations including clinical interviews, lifestyle questionnaires, sampling, and noninvasive imaging assessment of multiterritorial subclinical atherosclerosis (carotids, iliofemorals, aorta, and coronaries). PESA tracks the trajectories of atherosclerosis and associated disorders from early stages to the transition to symptomatic phases. A joint venture between the CNIC and the Santander Bank, PESA is expected to run until at least 2029, and its significant contributions to date are presented in this review paper. (J Am Coll Cardiol 2021;78:156-79) (c) 2021 Published by Elsevier on behalf of the American College of Cardiology Foundation.