Polyvascular Disease: A Narrative Review of Risk Factors, Clinical Outcomes and Treatment.

IF 3.1 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Current Cardiology Reports Pub Date : 2024-06-01 Epub Date: 2024-05-14 DOI:10.1007/s11886-024-02063-0
Manasi Tannu, Connie N Hess, J Antonio Gutierrez, Renato Lopes, Rajesh V Swaminathan, S Elissa Altin, Sunil V Rao
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Abstract

Purpose of review: Polyvascular disease has a significant global burden and is associated with increased risk of major adverse cardiac events with each additional vascular territory involved. The purpose of this review is to highlight the risk factors, associated outcomes, emerging genetic markers, and evidence for screening and treatment of polyvascular disease.

Recent findings: Polyvascular disease is the presence of atherosclerosis in two or more vascular beds. It has a significant global burden, with a prevalence of 30-70% in patients with known atherosclerosis. Patients with polyvascular disease experience elevated rates of cardiovascular death, myocardial infarction and stroke, especially among high-risk subgroups like those with type 2 diabetes mellitus and there is a step-wise increased risk of adverse outcomes with each additional vascular territory involved. Genetic analyses demonstrate that some individuals may carry a genetic predisposition, while others exhibit higher levels of atherogenic lipoproteins and inflammatory markers. Routine screening for asymptomatic disease is not currently recommended by major cardiovascular societies unless patients are high-risk. While there are no established protocols for escalating treatment, existing guidelines advocate for lipid-lowering therapy. Additionally, recent studies have demonstrated benefit from antithrombotic agents, such as P2Y12 inhibitors and low-dose anticoagulation, but the optimal timing and dosage of these agents has not been established, and the ischemic benefit must be balanced against the increased risk of bleeding in the polyvascular population. Due to the high prevalence and risks associated with polyvascular disease, early identification and treatment intensification are crucial to reduce disease progression. Future research is needed to develop screening protocols and determine the optimal timing and dosing of therapy to prevent ischemic events.

Abstract Image

多血管疾病:风险因素、临床结果和治疗的叙述性回顾。
审查目的:多血管疾病给全球带来沉重负担,每增加一个血管区域,就会增加发生重大心脏不良事件的风险。本综述旨在强调多血管疾病的风险因素、相关结果、新出现的遗传标记以及筛查和治疗多血管疾病的证据:多血管疾病是指两个或两个以上的血管床出现动脉粥样硬化。多血管疾病给全球带来沉重负担,在已知动脉粥样硬化的患者中发病率高达 30-70%。多血管疾病患者的心血管死亡、心肌梗死和中风发生率较高,尤其是在 2 型糖尿病患者等高风险亚群中,每增加一个血管区域,不良后果的风险就会逐步增加。基因分析表明,一些人可能具有遗传易感性,而另一些人则表现出较高水平的致动脉粥样硬化脂蛋白和炎症标志物。目前,主要的心血管协会都不建议对无症状疾病进行常规筛查,除非患者属于高危人群。虽然没有既定的升级治疗方案,但现有指南提倡降脂治疗。此外,最近的研究表明,P2Y12 抑制剂和小剂量抗凝等抗血栓药物可带来益处,但这些药物的最佳使用时机和剂量尚未确定,而且在多血管人群中,缺血益处必须与增加的出血风险相平衡。由于多血管疾病的高发病率和相关风险,早期识别和加强治疗对减少疾病进展至关重要。未来的研究需要制定筛查方案,并确定最佳治疗时机和剂量,以预防缺血性事件的发生。
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来源期刊
Current Cardiology Reports
Current Cardiology Reports CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
6.20
自引率
2.70%
发文量
209
期刊介绍: The aim of this journal is to provide timely perspectives from experts on current advances in cardiovascular medicine. We also seek to provide reviews that highlight the most important recently published papers selected from the wealth of available cardiovascular literature. We accomplish this aim by appointing key authorities in major subject areas across the discipline. Section editors select topics to be reviewed by leading experts who emphasize recent developments and highlight important papers published over the past year. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. We also provide commentaries from well-known figures in the field.
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