Discussion
A unifying concept in vascular
health, prolonged or chronic stimulation results in pathological
remodeling and leads to formation of morphologically and functionally
abnormal vessels. Healthy vessel is stable, that is the endothelium
rests on a basement membrane comprised mainly of laminins and type IV
collagen with associated glycoproteins but low levels of provisional
matrix proteins such as fibronectin and fibrin19, 20.
Many indicators are used to evaluate vascular stability, that is,
vascular health, including endothelial function, arterial stiffness, and
carotid atherosclerosis.
Studies have shown that endothelial
dysfunction is associated with a number of other vascular disease and
can predict CVD events2, 21. Recently measuring
endothelial function using PAT has gained increasing attention and a
proprietary device has been developed to measure observer independent
pulsatile arterial volume changes by finger plethysmography (EndoPAT,
Itamar Medical) 2, 22. Andreas J et al. found
non-invasive endothelial function measurements provide valuable
additional information, however, to ascertain its use for daily clinical
practice, future research should determine whether endothelial function
can be used to guide treatment in the individual and if this translates
into better outcomes2.
Arterial stiffness is associated
with cerebral small vessel disease and decreased cognitive
function23. A meta-analysis of 17 longitudinal studies
that evaluated aortic pulse wave velocity (PWV) and followed up 15,877
subjects for a mean of 7.7 years found aortic stiffness expressed as
aortic PWV was a strong predictor of future CV events and all-cause
mortality. The predictive ability of arterial stiffness is higher in
subjects with a higher baseline CV risk4.
A substantial global burden of carotid atherosclerosis exists. In people
aged 30–79 years in 2020, the global prevalence of increased CIMT is
estimated to be 27·6% (95% CI 16·9–41·3); of carotid plaque is
estimated to be 21·1% (13·2–31·5); and carotid stenosis is estimated
to be 1·5% (1·1–2·1) 24. Carotid plaque and carotid
stenosis are easily detected with duplex ultrasound because of the
superficially positioned carotid artery. CIMT and plaque consensus
suggested a standard for carotid image acquisition13,
14. People with carotid atherosclerosis are classified by the European
Society of Cardiology as having a very high risk of death from
CVD25. Advanced carotid atherosclerosis, defined as
50% or more stenosis, increases risk of CVD and carotid lesion-derived
stroke26.
CVD risk-assessment tools and
appropriate recommendations for risk assessment in clinical guidelines
are essential for implementation of a high risk CVD prevention strategy
in a population12, 27. Most guidelines and risk
assessment models are focused on traditional CV risks, such as age, sex,
SBP or hypertension, TC or ratio of TC to HDL cholesterol, smoking, HDL
cholesterol, obesity, diabetes mellitus and family history of premature
CVD or coronary heart disease (CHD)27. Although
several well-known models and algorithms for CVD risk assessment have
been developed 11, 27, 28, these models and guideline
recommendations might not be suitable for direct application in clinical
practice. In addition, an analysis of 5 risk scores, 4, including the
American Heart Association (AHA) and American College of Cardiology
(ACC) atherosclerotic cardiovascular disease (ASCVD) risk score, showed
overestimation of risk (25% to 115%) in a modern, multiethnic cohort
without baseline clinical ASCVD. If validated, overestimation of ASCVD
risk may have substantial implications for individual patients and the
health care system29. CVD risk assessment depends not
only on risk-factor profile, but also on the direct vascular health risk
levels, and relative risk of each vascular health factor.
The BVHS is a vascular health
grading system which completely takes blood vessels as the evaluation
target and takes the traditional CV risk factors as confounding factors.
By collecting vascular health data for hierarchical management, a
disease risk prediction model was further established. The risk of the
population was divided according to the vascular health results, and
different vascular health management suggestions were provided for
different populations. In addition, we will provide health management
follow-up platform for high-risk population, provide health science
education about disease progression for high-risk population, and
improve the quality of life and prevention awareness of adverse events
within a controllable range. Through the construction of medical
information, the information technology is applied to the management of
CVD chronic diseases, and the remote management mode of CVD is
constructed. This model is mainly a family-based application, which is
characterized by taking the population as the basis, taking the
bio-psycho-social medical model as the starting point, and taking the
elimination of risk factors as the primary task of management. At the
same time, we should pay attention to the relationship between clinical
data and daily data, comprehensively evaluate the health problems of
patients, and provide health management services for patients with CVD.
Risk assessment using vascular health as an alternative endpoint index
is helpful to early warning of CVD and make high-risk groups more
compliant with lifestyle intervention and drug therapy. Long-term and
lifelong vascular health assessment will become an important field of CV
risk assessment in the future and will enter a new period of individual
accurate risk assessment. Early non-invasive detection of subclinical
vascular lesions is the key step to reduce the death and disability of
CVD. The evaluation of vascular structure and function damage is of
great value for risk stratification and curative effect judgment of
patients.