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How to identify subjects with poly-vascular disease?
Charalambos Vlachopoulos1, Dimitrios Terentes-Printzios, Christodoulos Stefanadis
1Peripheral Vessels Unit, 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece. cvlachop@otenet.gr
Insights
Multisite artery disease affects 15.9% of patients with atherosclerosis risk factors. Identifying this condition may improve outcomes, but further evidence is needed to confirm its impact on secondary prevention programs.
Area of Science:
- Cardiovascular Medicine
- Atherosclerosis Research
- Vascular Biology
Background:
- Multisite artery disease, also known as polyvascular disease, is prevalent, affecting 15.9% of patients with established atherosclerotic arterial disease or multiple atherothrombosis risk factors.
- The presence of polyvascular disease is linked to increased risks of recurrent symptoms and complications in affected vascular beds.
- Current diagnostic approaches involve a comprehensive medical history, physical examination, and various non-invasive imaging techniques.
Purpose of the Study:
- To explore the diagnostic work-up and clinical implications of multisite artery disease.
- To evaluate the role of arterial biomarkers in predicting cardiovascular outcomes.
- To address the pending question of whether identifying multisite artery disease improves clinical outcomes in patients undergoing secondary prevention.
Main Methods:
- Review of existing literature and data from registries like REACH.
- Utilization of non-invasive imaging techniques such as duplex ultrasound, CT angiography, and MR angiography.
- Assessment of arterial biomarkers including arterial stiffness, central blood pressure, ankle-brachial index, and carotid intima-media thickness.
Main Results:
- Polyvascular disease is common and associated with higher risks.
- Arterial biomarkers show potential in predicting cardiovascular morbidity and mortality beyond traditional risk factors.
- The clinical benefit of identifying asymptomatic multisite artery disease in secondary prevention remains under investigation.
Conclusions:
- Multisite artery disease requires thorough screening and diagnosis.
- Arterial biomarkers offer valuable prognostic information.
- Further research is crucial to determine if targeted management of multisite artery disease improves patient outcomes in secondary prevention.
Abstract:
Multisite artery or polyvascular disease is common. In the REACH registry, 15.9% of patients with either established atherosclerotic arterial disease or at least 3 risk factors for atherothrombosis had symptomatic polyvascular disease. History of risk factors and known co-morbidities, as well as a thorough physical examination, are mandatory in the initial screening and diagnostic work-up. Various non-invasive imaging techniques (duplex ultrasound, computed tomography angiography, magnetic resonance angiography) can be used for the identification of the polyvascular patient. Digital subtraction angiography is now used almost exclusively in association with endovascular procedures. Appropriate implementation of each technique is based on international guidelines and a multidisciplinary discussion for each case. The presence of co-existing disease in a different vascular bed is associated with a higher risk of recurrent symptoms and complications in the first site. In this context, accumulating evidence suggests that arterial biomarkers, such as arterial stiffness (pulse wave velocity), central blood pressures, wave reflections indices, ankle-brachial index, carotid intimamedia thickness, as well as vasculogenic erectile dysfunction, can predict cardiovascular morbidity and mortality beyond classical risk factors and prediction models. An important pending question is whether identification of multisite arterial disease may improve clinical outcomes in patients who are already in secondary prevention programs. Such screening of asymptomatic multisite artery disease in patients with known CVD would be of paramount importance if it is ultimately proven with hard evidence that it should lead to a different management from the one proposed for CVD patients without multisite artery disease.
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