Healthy Vascular Aging
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See related article, pp 267–274
Decisions on preventative treatments can be based on single parameters, but in most cases, clinicians take more than one risk factor into account, as some negative indicators of risk can be outbalanced by other more favorable factors. This concept has led to the development of risk scores that integrate a multitude of cardiovascular risk factors; the Framingham Risk Score is one notable example.1 Although these scores work well on the population level, they are of limited use for individual risk prediction. A tendency to overestimate risk; differences in risk between populations, ethnicities, and social classes; general changes in population health from derivation of scores in historic samples and application to modern societies; and the fact that not all damaging and protecting factors that could play a role in an individual patient are taken into account explain why as clinicians we are often confronted with patients at seemingly high risk who do perfectly well even at advanced age and with patients at seemingly low risk who are struck by premature cardiovascular disease. In this era of precision medicine,2 we would like to offer not only individualized treatment options but also individualized preventative strategies to our patients.
An alternative approach is, therefore, based on early detection of cardiovascular disease rather than prediction of cardiovascular disease risk. The concept of the cardiovascular continuum where advanced disease develops not without earlier functional and structural subclinical changes forms the theoretical basis of this approach.3 One can assume that an individual’s position on the continuum from health to overt cardiovascular disease is determined by the integrated action of genetic, environmental, and other risk factors and could, therefore, inform decision rules on initiation of preventative and therapeutic strategies.4
Assessment of vascular function and structure is a key element …