Exploration into non-traditional risk factors of subclinical atherosclerosis in low-risk adults
Background: Atherosclerotic cardiovascular disease (ASCVD) manifests silently as subclinical atherosclerosis before a clinical event. Disparities in ASCVD risk, particularly among underrepresented ethnic and racial groups, underscore the need for comprehensive investigations into non-traditional ris...
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| Tipo de recurso: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2024 |
| País: | España |
| Institución: | CBUC, CESCA |
| Repositorio: | TDR. Tesis Doctorales en Red |
| OAI Identifier: | oai:www.tdx.cat:10803/692257 |
| Acceso en línea: | http://hdl.handle.net/10803/692257 |
| Access Level: | acceso abierto |
| Palabra clave: | Aterosclerosis Atherosclerosis Malalties cardiovasculars Enfermedades cardiovasculares Cardiovascular diseases Sistema cardiovascular Cardiovascular system Risc cardiovascular Riesgo cardiovascular Cardiovascular risk Factors de risc Factores de riesgo Risk factors Resistència a la insulina Resistencia a la insulina Insulin resistance 616.1 |
| Sumario: | Background: Atherosclerotic cardiovascular disease (ASCVD) manifests silently as subclinical atherosclerosis before a clinical event. Disparities in ASCVD risk, particularly among underrepresented ethnic and racial groups, underscore the need for comprehensive investigations into non-traditional risk factors. Additionally, the rising global burden of CV risk factors (CVRFs), including obesity and type 2 diabetes, highlights the urgency of exploring the effect of early indicators of disease like insulin resistance, which may precede overt metabolic changes and contribute to the subclinical atherosclerotic process. Methodology: This abstract synthesizes findings from two studies exploring the impact of ethnicity/race and early insulin resistance on the presence, burden, and extent of subclinical atherosclerosis in young adults, employing 2D and 3D vascular ultrasound and cardiac computed tomography. Study 1 examined 436 socioeconomically disadvantaged adults from the FAMILIA study (mean age 38 years) in Harlem, New York. Study 2 analyzed 3,741 individuals from the PESA study (mean age 46 years) in Madrid, employing the homeostatic model assessment of insulin resistance index (HOMA-IR) to assess early insulin resistance. Results: In the first study, after adjusting for traditional CVRFs and socioeconomic factors, non-Hispanic Black individuals had a significantly higher subclinical atherosclerosis prevalence (12.9%) than their Hispanic counterparts (6.6%), indicating heightened vulnerability. In Study 2, HOMA-IR values ≥3 (reference < 2) were associated with increased multiterritorial subclinical atherosclerosis (odds ratio 1.41; 95%CI: 1.01 to 1.95, p = 0.041) and coronary calcium scores > 0 (odds ratio 1.74; 95%CI: 1.20 to 2.54, p = 0.004), even after adjusting for key CVRFs and glycated hemoglobin, emphasizing its potential as an early marker to identify low-risk individuals with heightened risk. Conclusion: The revelations from the FAMILIA study underscore the need for targeted interventions, emphasizing urgency in mitigating social determinants and structural inequalities affecting CV health. Concurrently, the revelations from the PESA cohort underscore the transformative potential of HOMA-IR screening as a practical tool, thereby providing a concrete opportunity for clinicians to intervene at earlier stages, contributing to earlier and personalized preventive strategies in CV care |
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