Circulatory health - TOWARDS LIFE-KNOWLEDGE

Cardiovascular disease remains the leading cause of mortality worldwide despite major advances in clinical care. This persistent burden reflects a structural limitation: prevailing models are predominantly oriented toward downstream intervention rather than upstream condition design.

We propose a unifying framework in which circulatory health is understood as the stability of a multi-scale system shaped across the life course. Integrating insights from developmental biology, social and commercial determinants of health, and policy frameworks, we describe health as the dynamic balance between system load, capacity, and adaptive response.

This framework is aligned with the Sustainable Development Goals and WHO strategies, and extends these through a reframing of economic activity (SDG 8) and a One Health perspective linking human, societal, and planetary systems. We introduce a crosswalk that maps system dynamics to policy levers, enabling translation across domains.

This approach shifts the focus of cardiovascular health from reactive disease management to proactive condition design, with implications for clinical practice, public health, and governance. Health emerges not from intervention alone, but from the coherence of circulation across interconnected systems.

Cardiovascular disease remains the leading cause of global morbidity and mortality despite substantial advances in clinical care. This persistent burden reflects a structural limitation: health systems are predominantly oriented toward downstream intervention rather than upstream condition design.

This paper proposes a unifying framework in which circulatory health can be understood as the sustained coherence of a multi-scale system shaped across the life course. Integrating circulatory physiology, the Developmental Origins of Health and Disease, social and commercial determinants of health, and Health in All Policies, we argue that disease reflects the failure of coordinated function under constraint rather than isolated abnormalities in measurable variables.

Within this framework, prevention is reframed as the maintenance of conditions that preserve system coherence. We introduce the concept of structural indicators to detect early system drift and describe how distortion — defined as divergence between actual and perceived system state — can delay recognition and misdirect response.

This approach shifts the focus of cardiovascular health from reactive disease management to proactive condition design, with implications for clinical practice, public health, and policy.