Reshaping the cardiovascular continuum in the management of arterial and venous cardiovascular disease: a narrative review.

Abstract

The prevalence of cardiovascular disease (CVaD) is expected to double in the next 25 years, fueled by increasing prevalence of diabetes mellitus, obesity and hypertension. Cardiovascular-kidney-metabolic syndrome is a clinical entity requiring a holistic approach to prevention and management. Another aspect of this syndrome is chronic venous disease (CVeD), which is common in patients with CVaD. This review describes presentations at a symposium by the European Association of Preventive Cardiology (Milan, Italy; April 2025), discussing the interconnectedness of conditions on the CVaD continuum and their relationship with CVeD. Venous and arterial disease share common risk factors and pathogenic pathways, including endothelial dysfunction, increased vascular permeability, oxidative stress and inflammation. Many cardiometabolic and vascular conditions remain underdiagnosed and untreated, and the patients' level of risk is often underestimated. Examination of the legs is important to identify peripheral arterial disease and/or CVeD. The mainstays of treatment for CVeD are exercise, compression therapy, venoactive drugs and surgery. Failure to achieve and maintain treatment goals is usually the result of therapeutic inertia or poor medication adherence. A coherent approach is needed to identify and manage shared risk factors and comorbidities. Effective disease management and risk reduction require integrated care using multidisciplinary teams; evidence-based treatments, usually with combination therapy; and use of tools to maximize adherence, including digital tools and single-pill combinations to simplify treatment regimens in patients with multiple risk factors or comorbidities.