A look inside the arteries: moving from event rates to subclinical measures of disease

Cardiovascular disease (CVD) is still the most important cause of death worldwide, with ischaemic heart disease and stroke being the most frequent subcategories.1 Next to premature mortality, morbidity and reduced quality of life are consequences which can be devastating to the individual as well as to society. However, the final dreaded event, such as myocardial infarction, stroke or sudden cardiac death, caused by plaque rupture and thrombosis, presents only the very last stage of a disease process that has long been ongoing.2 The underlying pathology for most cardiovascular (CV) and many cerebrovascular events is atherosclerosis, a process that can start as early as in the first decade of life, resulting from a very complex aetiology.3 ,4 Work-related factors such as shift work, noise, physical workload, psychosocial stress and long working hours are occupational CVD risk factors that have been investigated for many decades.5 However, it is still partly unclear how these factors promote CVD and whether they influence the underlying pathology of atherogenesis. This issue of the journal presents one of the few studies so far investigating occupation and subclinical measures of atherosclerosis.6 Fujishiro et al report results from a population-based prospective cohort, investigating the association of occupational status and characteristics with progression of atherosclerosis. What makes this study particularly interesting is the use of longitudinal information on carotid plaque and carotid intima media thickness (CIMT) as …