As cardiovascular research continues to evolve, new ways of understanding circulation are expanding how clinicians think about day-to-day vascular function and long-term wellness.
Mainstream cardiology has mostly focused on large vessels, discrete biomarkers, and downstream clinical events. But as healthcare systems face mounting pressure to shift from late-stage intervention to earlier prevention, some clinicians are reexamining what happens upstream in the circulatory system. Among them is Dr. Michael Twyman, a St. Louis–based board-certified cardiologist whose work centers on the foundational biology that supports blood flow, organ function, and whole-body wellness.
At Calroy Health Sciences, Twyman approaches circulation through a vascular-first lens. Rather than relying solely on snapshot measurements, he emphasizes systems that help regulate moment-to-moment blood flow, including the endothelial layer, microcirculation, and the endothelial glycocalyx (EGX), a thin, gel-like structure lining blood vessels that plays a central role in vascular signaling and responsiveness.
This reflects a broader shift in preventive medicine as clinicians seek better ways to understand why standard screening results do not always align with how individuals feel in their daily lives.
What Emerging Research Is Revealing
Recent cardiovascular research has highlighted the importance of microvascular behavior, the network of very small blood vessels responsible for distributing blood within tissues.
Large-scale analyses published in recent years suggest that changes at the microvascular level can persist even when blood flow through major arteries appears restored. These findings have prompted researchers to examine how circulation functions beyond what conventional imaging and metrics capture.
Rather than focusing exclusively on whether blood vessels are open or closed, this body of research is encouraging clinicians to consider how efficiently the circulatory system adapts to routine demands, such as physical movement, cognitive activity, and recovery.
Why Traditional Metrics Leave Questions Unanswered
Many clinicians encounter individuals who report changes in stamina, mental clarity, or daily energy, even when commonly measured cardiovascular markers fall within expected ranges. This gap has drawn attention to the biological systems that regulate circulation continuously throughout the day.
“Most clinicians have never heard of the glycocalyx because it was essentially invisible for decades,” Twyman says. “You can’t manage what you can’t see.”
That is beginning to change. Advances in imaging and vascular biology have made it easier to study how the smallest blood vessels behave and how they influence organ function over time.
“Healthy microcirculation drives organ health,” Twyman notes. “Up to 99% of your blood vessels are tiny microvessels that determine how well your organs perform.”
This has shifted some clinical conversations away from a narrow focus on whether values cross a diagnostic line, toward broader questions about how well the circulatory system supports everyday function.
The Road from Discovery to Practice
Twyman often points to nitric oxide (NO) as an example of how long it can take for scientific discoveries to influence routine care.
Nitric oxide was identified decades ago as a key signaling molecule involved in blood vessel relaxation and vascular responsiveness. While its role is well established in research literature, its practical implications are still unfamiliar to many clinicians.
“The Nobel Prize for nitric oxide was awarded in 1998, yet it wasn’t heavily covered in my medical school or cardiology fellowship,” he says. “That’s how long translation can take.”
Digital education has begun to shorten that timeline. Podcasts, online lectures, and professional forums now allow new ideas to circulate far more quickly than traditional academic channels once allowed.
As a result, individuals are increasingly arriving to clinical visits with questions about endothelial function, microvascular health, and foundational circulatory biology.
Education, Collaboration, and Expanding the Clinical View
As interest in endothelial and glycocalyx research grows, organizations focused on vascular biology are working to translate complex findings into accessible education for clinicians.
Calroy Health Sciences supports research collaboration and educational initiatives centered on endothelial and glycocalyx function, guided by its Science and Medical Advisory Board. The goal is not to replace established cardiovascular guidelines, but to expand how clinicians think about circulation as a dynamic, system-wide process.
Where Circulatory Care Is Heading
Across preventive medicine, several themes are gaining momentum:
- Earlier attention to endothelial and microvascular function.
- Systems-level thinking that connects circulation to whole-body wellness.
- Lifestyle approaches aligned with nitric oxide signaling and glycocalyx support.
- Digital education that accelerates clinician and public understanding.
- Growing interest in foundational biology that supports circulation over time.
Together, these shifts reflect a gradual move toward understanding circulation not only as a cardiology concern but as a central component of overall health.
“You need blood flow to every organ system,” Twyman emphasizes. “If blood can’t deliver oxygen in and carry waste out, nothing downstream works the way it should.”
This perspective is helpful in reframing how a new generation of clinicians approaches vascular health, focusing on the systems that support daily function, adaptability, and long-term wellness.
FAQs for Clinicians
Why is the glycocalyx clinically relevant?
It helps sense blood flow, supports nitric oxide release, and maintains the structure and normal functions of the endothelium.
How does microcirculation relate to patient experiences?
Microvessels govern moment-to-moment circulation. Their behavior can influence how individuals experience activity, focus, and daily energy.
How does nitric oxide fit into early circulatory discussions?
NO is the body’s signaling molecule for vessel relaxation, helping support circulation and cardiovascular wellness.
Where do glycocalyx-supportive and NO-supportive tools fit?
They are often integrated into clinician-guided wellness plans that emphasize foundation-first approaches to circulatory health.
