ABSTRACT
The major issues in the natural history of cardiovascular disease have been brought together by Dzau et al. (Dzau et al., 2006a; Dzau et al., 2006b) in description of the cardiovascular continuum (Fig. 19.7). This concentrates on initial risk factors, and the development over time, of atherosclerotic disease with progression to coronary stenosis, myocardial ischemia, myocardial infarction, and scarring, with end-stage cardiac failure causing death if this does not occur before on account of a lethal arrhythmia. Such considerations led us to a new view on the link between macrovascular stiffening and the degeneration of microvasculature in the brain and kidney, which is a consequence of greater pulsatile flow entering these vessels and being cushioned therein rather than in the aorta and elastic arteries. These views are embraced as the cardiovascular aging continuum, which we see as the other side of the coin of the conventional continuum (or the other face of the cameo), and which explains how aging change even in the absence of atherosclerotic disease, can lead not only to myocardial ischemia, arrhythmia, and cardiac failure, but to cerebral and renal microvascular disease as well, with intellectual deterioration, dementia, and renal failure. We see both continua as applying in Western civilizations, but the aging process being of more importance now in developing nations with low prevalence of atherosclerotic disease and becoming more important in Western societies in the future as
atherosclerotic disease is controlled by better lifestyle, less smoking, and greater use of statins and antiplatelet agents. On the same wavelength are two terms that were recently coined, EVA which stands for early vascular aging and ADAM which stands for aggressive decrease of atherosclerosis modifiers (Fig. 22.1) (Nilsson et al., 2009).
