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Vascular aging: A tale of EVA and ADAM in cardiovascular risk assessment and prevention.

Cardiovascular disease (CVD) manifestations still pose a substantial threat to public health, as summarized in a recent report from the American Heart Association Statistics Committee for an update in 2009.1 Classic risk factors are of major importance to screen for, to evaluate, and to control with lifestyle advice or drug therapy. However, because the risk of CVD is still representing a challenge in spite of prevention and all treatment efforts, there is a need for new pathophysiological models for better understanding of cardiovascular risk and its treatment, based on new concepts.

It has been shown that target organ damage (TOD) represents a mediating step between risk factors and CVD events. Examples of well-established TOD categories include left ventricular hypertrophy and albumin excretion. In addition, substantial evidence has accumulated to show that arterial stiffness and increased pulse wave velocity (PWV), as well as central aortic pulse pressure, are important independent predictors of CVD events.2 These are in fact not only examples of TOD but also of the underlying pathological process, because increased PWV might determine the degree of left ventricular hypertrophy through increased arterial pulse wave reflection, central pulse pressure, and postload.2

Because aging is a common denominator to many chronic disease manifestations, eg, CVD, type 2 diabetes mellitus, or cancer, we propose that early vascular aging (EVA) could be a useful concept to better guide clinical investigations in subjects at increased cardiovascular (CV) risk. This could be the case in individuals with marginal elevation of classic risk factors or with a strong family history of early CVD manifestations. There might also be a special link between adverse growth patterns in fetal or early postnatal life (the “mismatch” growth hypothesis) and the EVA syndrome, as summarized recently.3

Vascular aging in general, and EVA more specifically, can be …