Beyond Unidirectional Injury: Bidirectional Interactions Between Arteriosclerosis and the Heart-Brain-Kidney Axis

Abstract

Arteriosclerosis is a systemic degenerative vascular disorder characterized by arterial wall thickening, reduced elasticity (arterial stiffness), and luminal narrowing, and is closely associated with aging and hypertension. Key pathological processes include lipid deposition, chronic inflammation, vascular calcification, and hemodynamic disturbances. These processes progressively injure high metabolic demand organs, including the heart, brain, and kidneys, through both direct vascular damage and indirect regulatory pathways. Conversely, injury to these target organs can activate compensatory and stress responses that further accelerate vascular remodeling, establishing a self-reinforcing cycle of “vascular-organ interactive injury.” This review summarizes mechanisms by which arteriosclerosis drives multi-organ damage, highlights related clinical manifestations and outcomes, discusses how cardiac, cerebral, and renal dysfunction feeds back to worsening vascular disease, and outlines current strategies for clinical assessment and intervention.