New approaches to screening for vascular and cardiac risk

Cardiovascular morbid events occur as a consequence of vascular and cardiac disease, which can be identified long before symptoms of organ involvement become apparent. Early detection of abnormalities in the small arteries, especially deficiency of endothelial nitric oxide bioactivity, and of structural changes of remodeling in the left ventricle can identify individuals at risk for morbid events. These individuals should be the target for aggressive lifestyle and pharmacologic interventions known to favorably affect the progression of disease. Techniques are now available for screening of asymptomatic individuals to detect early vascular and cardiac abnormalities likely to lead to progression of disease. Pulse wave analysis provides an assessment of small artery elasticity that appears to correlate with endothelial function. Left ventricular structural alterations can be assessed by ultrasound or by circulating levels of brain natriuretic peptide. The usefulness of these early screening techniques to encourage tailored interventions in susceptible individuals needs to be explored in large-scale trials.