ABSTRACT
Atherosclerotic disease comprises four major areas, coronary artery disease (CAD), cerebrovascular disease, peripheral arterial disease (PAD), and thoracic or abdominal aortic aneurysm. The ‘Cardiovascular Continuum’ was described by Dzau and colleagues in 2006 (Dzau et al., 2006a; Dzau et al., 2006b) to explain the development over many years of coronary disease with its complications, then end-stage heart failure. William Osler described two forms of arteriosclerosis, ‘nodular arteriosclerosis’ (atherosclerosis) and a disease which may be superimposed on arterial aging (his ‘senile arteriosclerosis’). While the cardiovascular continuum put an emphasis on atherosclerosis in prosperous nations, it did not account fully for the problems of aging, which occur in all societies. Aging of the thoracic aorta and elastic arteries causes arterial stiffening and leads to development of cardiac failure and microvascular disease in highly perfused organs, such as the brain and kidneys. We recently introduced the ‘Vascular Aging Continuum’ which dovetails with the late phases of the cardiovascular continuum and provides a more comprehensive explanation,
especially for vascular diseases in nations with little atherosclerosis (see also Chapter 22) (O’Rourke et al., 2010b).
