Vascular Integrity in Atherosclerotic Cardiovascular Disease (ASCVD): A Systems-Based Framework with Clinical Observations from a 10-Case Series

Background: Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality worldwide. Despite effective lipid-lowering therapies, substantial residual cardiovascular risk persists, suggesting that additional mechanisms beyond lipid accumulation contribute to disease progression.Objective: To examine vascular integrity as a central, yet under-addressed dimension of ASCVD, and to integrate current evidence with clinical observations from a series of 10 patients managed using a systems-based approach.Methods: This narrative review synthesizes literature on vascular biology, inflammation, and metabolic health, alongside a retrospective case series of 10 patients with ASCVD or vascular risk. Interventions included dietary modification, micronutrient support (including vitamin C and cofactors), and lifestyle optimization.Results: Clinical improvements were observed across the cohort in blood pressure stability, symptom burden, and vascular markers where available. Patterns suggest that addressing metabolic stress, inflammation, and nutrient status may contribute to improved vascular stability.Conclusion: Vascular integrity provides a unifying framework for understanding residual cardiovascular risk. A systems-based approach targeting structural and functional aspects of the vasculature may complement conventional lipid-focused strategies.