Abstract
With increasing age, the cardiovascular risk increases, as does frailty, with negative health consequences such as coronary disease, stroke, and vascular dementia. However, this aging process seems to take a more rapid course in some individuals, as reflected in the Early Vascular Aging (EVA) syndrome that over the recent 10 years has attracted increased attention. The core of the EVA syndrome is arterial stiffness in the media layer of large elastic arteries, a process that can be measured by pulse wave velocity, for example, along the aorta. Hypertension is a well-known cardiovascular risk factor in its own right, but also linked to the EVA process. However, several studies have shown that non-hemodynamic factors also contribute to arterial stiffness and EVA, such as impaired glucose metabolism, chronic inflammation, and oxidative stress. New perspectives have been introduced for linking early life programming affecting new-born babies and birth weight, with a later risk of hypertension, arterial stiffness and EVA. New drugs are being developed to treat EVA when lifestyle intervention and conventional risk factor controlling drugs are not enough. Finally, the opposite phenotype of EVA is Healthy Vascular Aging (HVA) or even Super Normal Vascular Aging (SUPERNOVA). If protective mechanisms can be found and mapped in these fortunate subjects with a slower than expected aging process, there could exist a potential to find new drug targets for preventive therapy.
Highlights
Reviewed by: Carmine Savoia, Sapienza University of Rome, Italy Stefano Omboni, Istituto Italiano di Telemedicina, Italy
Patients with essential hypertension have an increased risk of cardiovascular disease (CVD), because of the hemodynamic burden inflicted by elevated blood pressure, and due to the fact that hypertension often clusters with a number of cardiovascular risk factors in the same individual as described by the Lancet Commission on Hypertension 2016 [1]
Treatment of hypertension will lower the degree of arterial stiffness, and new antidiabetic drugs with favorable effects on the arterial wall can lower both office as well as ambulatory blood pressure impaired glucose metabolism is closely associated with vascular aging when measured by PWV [9, 10] it makes sense to offer the measurement of fasting glucose or even an oral glucose tolerance test (OGTT, 75 g glucose) to risk subjects, for example, following a myocardial infarction
Summary
Reviewed by: Carmine Savoia, Sapienza University of Rome, Italy Stefano Omboni, Istituto Italiano di Telemedicina, Italy. The cardiovascular risk increases, as does frailty, with negative health consequences such as coronary disease, stroke, and vascular dementia This aging process seems to take a more rapid course in some individuals, as reflected in the Early Vascular Aging (EVA) syndrome that over the recent 10 years has attracted increased attention. Patients with essential hypertension have an increased risk of cardiovascular disease (CVD), because of the hemodynamic burden inflicted by elevated blood pressure, and due to the fact that hypertension often clusters with a number of cardiovascular risk factors in the same individual as described by the Lancet Commission on Hypertension 2016 [1] This was previously often referred to as the Metabolic syndrome, based on its most recent definition in 2009 with its components of abdominal obesity, dyslipidaemia, hyperglycemia, and elevated blood pressure [2]. In a recent study in patients undergoing coronary angiography, who thereby had their central hemodynamics measured at the same time, it was shown that most devices providing a direct measurement of central hemodynamic and aortic c-f PWV are reliable, but not all devices provided indirect measurements; for example, using age and systolic blood pressure in their algorithm for indirect estimation of aortic PWV [7]
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