Panvascular disease – Epidemiology and prevention

Atherosclerosis is a progressive, general disease, affecting all arterial beds. Atherosclerosis starts in the youth [1] and aggravates in time, more or less quickly, according to the associated risk factors and genetic background. The simultaneous presence of clinically relevant atherosclerotic lesions in at least two major vascular territories defines the multisite artery disease or panvascular disease (PVD). This represents the situations where ischaemic symptoms are present, concomitant, or successive during patient's history and/or in the presence of multiple subclinical arterial lesions at significant risk of clinical manifestation in the future, affecting two or more distinct territories. The prevalence of PVD in general population is poorly studied but is sharply increasing with age and accumulation of common cardiovascular risk factors. Patients with PVD are at increased risk of further cardiovascular events, either fatal or nonfatal. In contrast, gaps in comprehensive care of these patients are frequent. Many studies are concordant to underline poorer management of these patients compared to single-bed artery disease, especially if there is no evidence of significant associated coronary artery disease. Therefore, a full cardiovascular work-up should be proposed in a screening/preventive programme in asymptomatic patients in order to primarily assess their cardiovascular risk. © 2017 The Czech Society of Cardiolog

Polyvascular disease: A narrative review of current evidence and a consideration of the role of antithrombotic therapy.

Polyvascular disease (PVD) affects approximately 20% of patients with atherosclerosis and is a strong independent risk factor for ischemic outcomes. However, guidelines do not address screening or treatment for PVD, and there have been no PVD-specific trials. We reviewed subgroup analyses of large randomized controlled trials of more intense antithrombotic therapy to determine whether increased intensity of therapy improved ischemic outcomes in patients with PVD. MEDLINE, MEDLINE in-Process, EMBASE, and the Cochrane Library were queried for randomized controlled trials larger than 5000 patients evaluating secondary prevention therapies in patients with coronary artery disease or lower extremity peripheral artery disease. Thirteen trials were included ranging in size from 7243 to 27,395 patients. In 9 trials (CHARISMA, TRA 2°P-TIMI 50, PEGASUS-TIMI 54, VOYAGER PAD, TRACER, EUCLID, TRILOGY ACS, PLATO, and COMPASS), patients in the PVD subgroup treated with increased-intensity antithrombotic therapy had similar or greater relative risk reductions for ischemic events in comparison with the general trial cohorts. In four trials (DAPT, THEMIS, APPRAISE-2, and ATLAS ACS 2 TIMI 51), the PVD subgroup had an increased hazard of ischemic events with increased-intensity therapy compared with the general trial cohorts. More intense antithrombotic therapy in patients with PVD was associated with a similar relative risk reduction for ischemic events compared with patients without PVD. Therefore, patients with PVD benefit from a larger absolute risk reduction because of their higher baseline risk. Future trials in patients with atherosclerotic cardiovascular disease should intentionally include PVD patients to adequately assess treatment options for this under-studied, under-treated population

2018 Practice guidelines for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension

These practice guidelines on the management of arterial hypertension are a concise summary of the more extensive ones prepared by the Task Force jointly appointed by the European Society of Hypertension and the European Society of Cardiology. These guidelines have been prepared on the basis of the best available evidence on all issues deserving recommendations; their role must be educational and not prescriptive or coercive for the management of individual subjects who may differ widely in their personal, medical and cultural characteristics. The members of the Task Force have participated independently in the preparation of these guidelines, drawing on their academic and clinical experience and by objective examination and interpretation of all available literature. A disclosure of their potential conflict of interest is reported on the websites of the ESH and the ESC