# Reshaping the cardiovascular continuum in the management of arterial and venous cardiovascular disease: a narrative review

## TL;DR

This review highlights the connection between arterial and venous cardiovascular diseases and emphasizes the need for a holistic, integrated approach to their management.

## Contribution

The paper introduces a unified perspective on managing both arterial and venous cardiovascular diseases through shared risk factor identification and treatment.

## Key findings

- Arterial and venous diseases share common risk factors and pathogenic pathways.
- Therapeutic inertia and poor medication adherence hinder effective treatment outcomes.
- Integrated care with multidisciplinary teams and simplified treatment regimens improves disease management.

## Abstract

The prevalence of cardiovascular disease (CVaD) is expected to double in the next 25 years, fueled by increasing prevalence of diabetes mellitus, obesity and hypertension. Cardiovascular–kidney–metabolic syndrome is a clinical entity requiring a holistic approach to prevention and management. Another aspect of this syndrome is chronic venous disease (CVeD), which is common in patients with CVaD. This review describes presentations at a symposium by the European Association of Preventive Cardiology (Milan, Italy; April 2025), discussing the interconnectedness of conditions on the CVaD continuum and their relationship with CVeD. Venous and arterial disease share common risk factors and pathogenic pathways, including endothelial dysfunction, increased vascular permeability, oxidative stress and inflammation. Many cardiometabolic and vascular conditions remain underdiagnosed and untreated, and the patients’ level of risk is often underestimated. Examination of the legs is important to identify peripheral arterial disease and/or CVeD. The mainstays of treatment for CVeD are exercise, compression therapy, venoactive drugs and surgery. Failure to achieve and maintain treatment goals is usually the result of therapeutic inertia or poor medication adherence. A coherent approach is needed to identify and manage shared risk factors and comorbidities. Effective disease management and risk reduction require integrated care using multidisciplinary teams; evidence-based treatments, usually with combination therapy; and use of tools to maximize adherence, including digital tools and single-pill combinations to simplify treatment regimens in patients with multiple risk factors or comorbidities.

This article describes the common features of cardiovascular disease (CVaD) and chronic venous disease (CVeD) and encourages a holistic approach to their management. This includes actively looking for CVeD in patients with CVaD (and vice versa) and prescribing effective treatments for both conditions. The article also raises awareness of the effect on health outcomes of adherence (patients taking treatment regularly as prescribed) and therapeutic inertia (doctors failing to appropriately escalate treatment to meet patient needs).

Risk factors for CVaD, such as obesity, diabetes and hypertension (high blood pressure), affect the structure and function of blood vessels (arteries and veins). The resulting damage to arteries has a negative effect on the heart and kidneys, and eventually causes significant health events, such as stroke, heart attack or kidney failure. Damage to veins causes CVeD, which is associated with varicose veins, leg pain, skin problems and leg ulcers. Although CVaD and CVeD are closely related, many doctors do not see them that way.

A symposium on CVaD and CVeD was held at the European Association of Preventive Cardiology annual congress in Milan, Italy on 4 April 2025. This article highlights the presentations at the symposium.

In both CVaD and CVeD, therapeutic inertia can be overcome by actively diagnosing risk factors, managing risk factors and symptoms with evidence-based therapies, monitoring the effect of treatment on the patient, and changing the medication if treatment goals are not being met. Adherence can be maximized by choosing medication that is easy for patients to take (e.g., once daily medications, single-pill combinations), using digital tools to deliver reminders and feedback, and investigating and removing (where possible) other barriers that affect a patient’s medication-taking behavior.

This article describes presentations at a symposium held at the European Association of Preventive Cardiology annual congress on reducing the risk and optimizing the management of cardiovascular disease, which often occurs with chronic venous disease, in patients with multiple risk factors or comorbidities.