Telomere length is associated with arterial damage in the CORDIOPREV study

BACKGROUND: Telomere length (TL) has emerged as a recognized biomarker of biological aging and cardiovascular risk. Several studies have associated short TL with increased incidence of cardiovascular disease and adverse outcomes. However, its value as a predictor of arterial injury remains unclear, especially in secondary prevention. This study examined the baseline association between TL and common carotid intima-media thickness (IMT-CC) in patients with coronary heart disease (CHD). METHODS: Of the 1002 CHD patients enrolled in the CORDIOPREV study, 903 completed baseline assessments of IMT-CC and TL. IMT-CC was measured bilaterally using high-resolution B-mode Doppler ultrasonography and categorized, according to the European Society of Cardiology guidelines, into three groups reflecting arterial injury: <0.7mm, 0.7-0.9mm, and ≥0.9mm. TL was determined using the quantitative PCR method. Patients were classified as at risk of short TL if their value was below the 20th percentile, and as non-risk if above this threshold. RESULTS: Patients with the highest IMT-CC values (≥0.9mm) had significantly shorter TL compared to those in the lowest group (<0.7mm, p=0.005), with a progressive decrease across IMT-CC categories (p for trend=0.02). The proportion of participants at risk of short telomeres increased significantly from 15% to 30% across these categories (p<0.001). In addition, the highest IMT-CC group showed a twofold greater risk of short telomeres compared to the reference group (<0.7mm; OR 2.373, 95%CI 1.4962-3.764), while no significant association was observed for the intermediate IMT-CC group (0.7-0.9mm; OR 1.352, 95%CI 0.896-2.039). CONCLUSIONS: In CHD patients, shorter TL is associated to advanced subclinical arterial damage, supporting its potential role as a complementary biomarker for vascular aging and improved risk stratification in secondary prevention.