More than a matter of the heart: the concept of intravascular multimorbidity in cardiac rehabilitation

ABSTRACT

Introduction

Coronary artery disease (CAD) is the major cause of death of cardiovascular disease. It is initiated by atherosclerosis, which narrows the coronary arteries and limits blood flow and oxygen to the heart. Multiple pathophysiological conditions within the arteries, such as arterial wall thickening, endothelial dysfunction, and arterial stiffening, are associated with the development of atherosclerosis.

Areas covered

We introduce a new concept of ‘intravascular multimorbidity,’ the presence and integration of multiple pathophysiological conditions within the arteries. We also introduce some measurements of intravascular multimorbidity and discuss how these measurements can be utilized in cardiac rehabilitation (CR).

Expert opinion

We propose that the measures of intravascular multimorbidity in different arteries may provide information on disease severity and serve as unique prognostic ‘barometers’ to disease progression in patients with CAD. By measuring the underlying disease mechanisms within the arteries and understanding individual variability of disease progression/regression, these measures may also provide a unique prognostic window in CR. The window into intravascular multimorbidity can help guide clinical strategies, for example, assessing progress and appropriate titration of exercise. Intravascular multimorbidity may represent an important opportunity for more researchers and clinical professions to evaluate patients in CR.

KEYWORDS:

• Arterial stiffness
• cardiac rehabilitation
• endothelial function
• flow-mediated dilation
• pulse wave velocity
• review
• vascular function

Article highlights

• Intravascular multimorbidity describes the presence and integration of multiple pathophysiological conditions within the arteries, associated with the development of atherosclerosis.

• Intravascular multimorbidity includes changes in arterial function and/or structure, such as arterial wall thickening, endothelial dysfunction, and arterial stiffening.

• Non-invasive measures of intravascular multimorbidity in different arteries, such as the carotid artery (intima-media thickness), brachial artery (flow-mediated dilation), and carotid to femoral artery (pulse wave velocity), have been widely used in research due to the relationship to risks of coronary artery disease.

• Measures of intravascular multimorbidity in different arteries may provide information on disease severity and serve as unique prognostic ‘barometers’ to disease progression for patients with coronary artery disease.

• Intravascular multimorbidity can be modified by an exercise-based cardiac rehabilitation program, and the measures may provide a unique prognostic window for assessing progress and appropriate titration of exercise for patients undergoing cardiac rehabilitation.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. 

Additional information

Funding

This paper was supported in part by the American Heart Association grant 20POST35120466 (CLH).