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To study the association between SA burden and an ischaemic scar (IS), identified by cardiac magnetic resonance (CMR), as a surrogate of CV endpoint, in a low-risk population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>A cohort of 712 asymptomatic middle-aged individuals from the Progression of Early SA (PESA-CNIC-Santander) study (median age 51 years, 84% male, median SCORE2 3.37) were evaluated on enrolment and at 3-year follow-up with 2D\/3D vascular ultrasound (VUS) and coronary artery calcification scoring (CACS). A cardiac magnetic study (CMR) was subsequently performed and IS defined as the presence of subendocardial or transmural late gadolinium enhancement (LGE). On CMR, 132 (19.1%) participants had positive LGE, and IS was identified in 20 (2.9%) participants. Individuals with IS had significantly higher SCORE2 at baseline and higher CACS and peripheral SA burden (number of plaques by 2DVUS and plaque volume by 3DVUS) at both SA evaluations. High CACS and peripheral SA (number of plaques) burden were independently associated with the presence of IS, after adjusting for SCORE2 [OR for 3rd tertile, 8.31; 95% confidence interval (CI) 2.85\u201324.2; P &amp;lt; 0.001; and 2.77; 95% CI, 1.02\u20137.51; P = 0.045, respectively] and provided significant incremental diagnostic value over SCORE2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In a low-risk middle-aged population, SA burden (CAC and peripheral plaques) was independently associated with a higher prevalence of IS identified by CMR. These findings reinforce the value of SA evaluation to early implement preventive measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration<\/jats:title>\n                    <jats:p>Progression of Early Subclinical Atherosclerosis (PESA) Study Identifier: NCT01410318.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjci\/jeae044","type":"journal-article","created":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T09:23:49Z","timestamp":1709285029000},"page":"968-975","source":"Crossref","is-referenced-by-count":14,"title":["Association between subclinical atherosclerosis burden and unrecognized myocardial infarction detected by cardiac magnetic resonance in middle-aged low-risk adults"],"prefix":"10.1093","volume":"25","author":[{"given":"Leticia","family":"Fern\u00e1ndez-Friera","sequence":"first","affiliation":[{"name":"Centro Nacional de Investigaciones Cardiovasculares (CNIC) , Melchor Fern\u00e1ndez Almagro 3, 28029, Madrid , Spain"},{"name":"HM CIEC MADRID (Centro Integral de Enfermedades Cardiovasculares), Hospital Universitario HM Monteprincipe, HM Hospitales , Av. de Montepr\u00edncipe, 25, 28660 Boadilla del Monte, Madrid , Spain"},{"name":"CIBERCV , Madrid , Spain"},{"name":"Universidad Camilo Jose Cela , Castillo de Alarc\u00f3n, 49, 28692 Villafranca del Castillo, Madrid , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Garc\u00eda-Alvarez","sequence":"additional","affiliation":[{"name":"Centro Nacional de Investigaciones Cardiovasculares (CNIC) , Melchor Fern\u00e1ndez Almagro 3, 28029, Madrid , Spain"},{"name":"CIBERCV , Madrid , Spain"},{"name":"Cardiology Department, Hospital Clinic Barcelona-IDIBAPS. 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