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.