The thousand faces of vascular disease

By Cristiano Antonino On Nov 2, 2022

Speaking of vascular disease immediately induces two broad categories of ideas

On the side of the global phenomenon, we mean everything that involves the arterial and venous vessel as the object of an insult: the fact that it occludes, preventing the passage of blood downstream of the obstruction (ischaemia), the fact that it ruptures (haemorrhage), the fact that – as it deteriorates – it does not allow those adaptive phenomena that normally guarantee the adequate flow of blood in relation to the demands of the various tissues of the organism during environmental exchanges (arteriosclerosis or rather, as we shall see, endothelial dysfunction).

On the clinical side, vascular disease is identified with the organs irradiated by the blood and thus, translatively, with the specialised pathology of the organ that ends up becoming the main victim of the vascular disease itself.

Hence, we are talking about cardiovascular diseases that are the main prerogative of cardiologists, about ischemic diseases of the limbs that are the subject of vascular surgeons and angiologists, but also, in this regard, about ischemic diseases of the bones and joints, which then become the ‘property’, by competence, of orthopaedists.

We could go on citing all medical specialisations, because in reality there is no ‘apparatus’ that does not have ischaemia, haemorrhage or arteriosclerosis among its possible diseases.

The ‘globalisation’ of vascular disease

In the case of the nervous system, the problem takes on gigantic proportions: cerebrovascular disease is by far the most frequent form of clinical presentation the neurologist encounters in the course of his practice.

If we add to the vascular pathology related to the diseases of the large arteries and veins of the central nervous system (cerebral infarction and haemorrhage) the pathology of the ‘thinner’ branches of the circulatory system, i.e. the arterioles, venules, down to the microscopic structures consisting of the blood capillaries that nourish all the nerve tissues and their vicinity, the size of the object of observation ends up pervading almost all areas of knowledge in neuropathology and, on the district level, overcoming classical anatomo-functional distinctions, first and foremost the delimitation between the central and peripheral nervous system.

In other words, the pathology of the structure of the blood vessels is a unifying element that encompasses, through the mechanisms of its formation, the nervous system in its unity, from the sophisticated cortico-subcortical circuits of the encephalon down to the fine nerve branches of the skin of the big toe.

This ‘globalisation’ of the vascular insult, both microscopic and macroscopic – for this reason respectively referred to by the binomial macroangiopathy-microangiopathy – has promoted an exponentially growing proflux of cytological, histological and biomolecular research into its nature and triggering mechanisms over the last 50 years.

The risk factors of vascular disease

The highroad that led to this enormous amount of basic research was undoubtedly the cataclysmic shift in the epidemiology of diseases in the West, from which the attribution of so-called ‘environmental risk factors’ originated.

Aside from the obvious – albeit rather variable and extremely incisive – genetically determined heredity for vascular disease risk, researchers began to assess the ‘sneaky enemies’ associated with our modern life: smoking, alcohol, diet, sedentary lifestyle, mental and emotional stress, i.e. those conditions which, unlike genetic factors, could be susceptible to variation and thus affect the risk of chronic disability and premature death.

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