This review shows that atherosclerosis is not merely a late-life clinical disease, but a widespread silent substrate detectable across middle age, inflammatory disease, metabolic risk, genetic susceptibility, and even apparently low-risk populations. The full paper is worth reading because it maps where conventional risk scores may underestimate real vascular burden—and where selective imaging could redefine prevention.
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Abstract: To synthesize evidence on the prevalence of clinical and subclinical atherosclerosis across general, high-risk, and specific disease populations, and to identify the demographic, metabolic, and environmental factors associated with increased disease burden. The review was built from 2,485 included records, including 2,307 original studies, and cites 177 key references. The mapped evidence indicates that subclinical atherosclerosis is a pervasive signal across the lifespan, with imaging-detected plaque exceeding 50% in many middle-aged cohorts, reaching approximately 63% multiterritorial involvement in adults aged 40–54 years, and surpassing 80% in elderly populations. Recurrent topic-level signals support a role for chronic inflammatory states—including rheumatoid arthritis, psoriasis, systemic lupus erythematosus, and human immunodeficiency virus infection—in amplifying prevalence beyond traditional risk prediction, with examples such as 77% multiterritorial burden in moderate-to-severe psoriasis and coronary prevalence of 54% versus 42% in people with human immunodeficiency virus. Metabolic disturbances, dysglycaemia, chronic kidney disease, familial hypercholesterolaemia, and environmental exposures including lead, air pollution, and tobacco smoke emerged as consistent prevalence amplifiers, while higher cardiorespiratory fitness and physical activity were associated with lower burden. Substantial prevalence in ostensibly low-risk or young adults, including 35.9% coronary involvement in asymptomatic adults without traditional risk factors and early lesions documented from ages 15–34, highlights that conventional risk scores may underestimate true atherosclerotic burden and supports a clinical case for selective imaging-based reclassification in inflammatory, metabolic, and genetically susceptible groups. Heterogeneity across imaging modalities, vascular beds, and population contexts remains a major limitation of the mapped evidence. Future research should prioritize harmonized multiterritorial imaging protocols and prospective cohorts that integrate inflammatory, metabolic, genetic, and environmental exposures to refine prevalence-based prognostic stratification in populations currently considered low-risk.
Final search date and database lock: 2026-04-24 20:09:42 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 9407
Downloaded Abstracts/Papers: 4050
Included original and non-original Abstracts/Papers (all): 2485
Included original Abstracts/Papers (Vote counting by direction of effect): 2307
Reference Index (links used in paper): 177
Total participants (topic deduplicated ΣN): 9806460
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Reference Index (177)
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