Shifted vascular optimization: the emergence of a new arteriolar behaviour with chronic metabolic disease.

This review is based on the presentation 'Shifted vascular optimization: the emergence of a new arteriolar behaviour with chronic metabolic disease', given at the Symposium 'Understanding Complex Behaviours in the Microcirculation: from Blood Flow to Oxygenation' during the Annual Meeting of the Physiological Society at the Aberdeen Exhibition and Conference Centre in Aberdeen, UK in July 2019. The past years of dedicated investigation on linkages between vascular (dys)function under conditions of elevated cardiovascular disease risk and tissue/organ performance have produced results and insights that frequently suffer from limited correlation and causation. Reaching out from this challenge, it was proposed that this may reflect a 'level of resolution' argument and that altered haemodynamic behaviour in vascular networks could be a stronger predictor of functional outcomes than higher resolution measures. Using this approach, we have determined that an attractor that describes the spatial and temporal shift in perfusion distribution at successive arteriolar bifurcations within the skeletal muscle is a strong predictor of functional outcomes within animals and provides novel insight into fundamental mechanistic contributors to altered patterns of intra-muscular perfusion. This article focuses on the applicability and utility of the attractor in models of cardiovascular and metabolic disease risk of increasing severity. We will also discuss the utility of the attractor in terms of understanding the effectiveness of aggressive interventions for reversing established vasculopathy and perfusion impairments.