Barbarians at the Gate: Vascular Age as an Opportunity to Timely Prevent Atherosclerotic Cardiovascular Disease

Abstract

The paradigms for precision cardiovascular medicine are undergoing continuous evolution and growth. With ongoing investigations of the role of genetic risk integrated into clinical assessment, current recommendations offer biomarker-and imaging-based risk-enhancing factors to individualize approach to each patient. Carotid intima-media thickness (CIMT) provides a reliable marker of vascular aging in young people, in whom plaque formation or calcification has not been established yet. When individualizing the treatment decision at the point-of-care, the population-based strategy may underperform in certain cohorts, especially younger individuals. Therefore, a comprehensive approach tailored toward the specific population is needed to provide further optimization of long-term care. Using the “vascular age” concept in shared decision-making may assist in better communicating the risk between the provider and the patient, furthering the focus on value-based care. This review is focused on the role of vascular age and CIMT as risk-enhancing imaging factors in identifying younger individuals at higher risk for atherosclerotic cardiovascular disease in the primary prevention setting to guide personalized prevention. Research is needed to evaluate whether early CIMT screening would affect uptake of risk-reducing interventions by the providers and patients as well as determine cost-effectiveness of the ultrasound-based surveillance intervals.