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Polyvascular Disease: A Narrative Review of Risk Factors, Clinical Outcomes and Treatment

  • Ischemic Heart Disease (D Mukherjee, Section Editor)
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Abstract

Purpose of Review

Polyvascular disease has a significant global burden and is associated with increased risk of major adverse cardiac events with each additional vascular territory involved. The purpose of this review is to highlight the risk factors, associated outcomes, emerging genetic markers, and evidence for screening and treatment of polyvascular disease.

Recent Findings

Polyvascular disease is the presence of atherosclerosis in two or more vascular beds. It has a significant global burden, with a prevalence of 30–70% in patients with known atherosclerosis. Patients with polyvascular disease experience elevated rates of cardiovascular death, myocardial infarction and stroke, especially among high-risk subgroups like those with type 2 diabetes mellitus and there is a step-wise increased risk of adverse outcomes with each additional vascular territory involved. Genetic analyses demonstrate that some individuals may carry a genetic predisposition, while others exhibit higher levels of atherogenic lipoproteins and inflammatory markers. Routine screening for asymptomatic disease is not currently recommended by major cardiovascular societies unless patients are high-risk. While there are no established protocols for escalating treatment, existing guidelines advocate for lipid-lowering therapy. Additionally, recent studies have demonstrated benefit from antithrombotic agents, such as P2Y12 inhibitors and low-dose anticoagulation, but the optimal timing and dosage of these agents has not been established, and the ischemic benefit must be balanced against the increased risk of bleeding in the polyvascular population.

Summary

Due to the high prevalence and risks associated with polyvascular disease, early identification and treatment intensification are crucial to reduce disease progression. Future research is needed to develop screening protocols and determine the optimal timing and dosing of therapy to prevent ischemic events.

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Dr. Gutierrez reports grants from the Department of Veterans Affairs.

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Authors and Affiliations

  1. Division of Cardiology, Duke University Health System, Durham, NC, USA

    Manasi Tannu, J. Antonio Gutierrez, Renato Lopes & Rajesh V. Swaminathan

  2. Duke Clinical Research Institute, Durham, NC, USA

    Manasi Tannu, Renato Lopes & Rajesh V. Swaminathan

  3. University of Colorado, School of Medicine and CPC Clinical Research, Aurora, CO, USA

    Connie N. Hess

  4. Yale University School of Medicine, New Haven, CT, USA

    S. Elissa Altin

  5. NYU Langone Health System, New York, NY, USA

    Sunil V. Rao

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M.T. and C.S. research data for the article and wrote the manuscript. S.R. proposed the idea and overall structure of the manuscript. All other authors contributed substantially to the discussion of content and reviewed and/or edits the manuscript before submission.

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Correspondence to Manasi Tannu.

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Dr. Rao reports no relationships with industry. Dr Tannu reports no conflicts. Dr. Hess reports receiving salary support from CPC Clinical Research; a member of the Executive Committee for EVOLVE-MI; and a grant from Amgen to CPC Clinical Research to fund the EVOLVE-MI trial. Dr. Lopes reports grants from Amgen, Bristol-Myers Squibb, GlaxoSmithKline, Medtronic, Pfizer, and Sanofi; consulting fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, and Novo Nordisk; payment or honoraria from AstraZeneca, Daiichi Sankyo, Novo Nordisk, and Pfizer. The other authors declare that they have no conflict of interest.

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Tannu, M., Hess, C.N., Gutierrez, J.A. et al. Polyvascular Disease: A Narrative Review of Risk Factors, Clinical Outcomes and Treatment. Curr Cardiol Rep (2024). https://doi.org/10.1007/s11886-024-02063-0

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