Vascular medicine in the 21st century: Embracing comprehensive vasculature evaluation and multidisciplinary treatment

Table 1 A comparison of key elements in the existing approach and the proposed model

Aspect	Existing approach	Proposed model
Guidelines	Focus on treatment	Focus should be on prevention and early detection
Risk assessment	Relies on established risk assessment tools, mainly for coronary artery disease. Only at the individual level	Expands risk assessment to include all vascular events, using a modified risk score that considers various vascular diseases. Should be expanded to identify subpopulations at risk
Treatment approach	Standard treatments for vascular diseases. Response guided approach to diagnosed conditions	Tailored treatment to individual patients and timing based on findings, prioritizing preventive measures
Multidisciplinary assessment	Diverse medical specialists are involved, but each concentrate on his/her respective field. Collaboration should be involved, but currently it is not systematic	Promotes a multidisciplinary approach involving vascular specialists, imaging specialists, hematologists, rheumatologists, and vascular and cardiac surgeons, led by a vasculature specialist who coordinates the process
Medical specialty	Cardiology focuses primarily on the heart	Vascular medicine becomes a broader specialty

Table 2 A comparison of future aspects in the existing approach and the proposed model

Aspect	Existing approach	Proposed model
Genetic factors	Limited incorporation of genetic data	Explores genetic factors influencing atherosclerosis and medication response
Artificial intelligence tools	Sporadic use in a given step of the process	Systematic use in risk assessment, prediction, detection, diagnosis, possible outcomes and treatment of vasculature diseases, and in optimizing clinical decision-making
Imaging modalities	Commonly uses computerized tomography angiography and ultrasound	Considers the use of whole-body MRI/ magnetic resonance angiography for comprehensive vascular evaluation including routine liver fat content (in all abdominal MRI results)
Advances technologies	Not extensively discussed	Emphasizes nanotechnology for vascular lesion investigation and treatment
The microbiome	Acknowledgment of microorganism diversity role in atherosclerotic process	Using knowledge about microbiome for risk assessment, prevention, and treatment of cardiovascular disease
Economic aspects	Limited discussion of economic factors and their implications	Discusses economic aspects, including cost-effectiveness, resource allocation, preventive measures, technological advances, research funding, patient-centered care, and healthcare disparities

MRI: Magnetic resonance imaging.