Age and vascular aging: an unexplored frontier

Abstract

Vascular age is an emerging field in cardiovascular risk assessment. This concept includes multifactorial changes in the arterial wall, with arterial stiffness as its most relevant manifestation, leading to increased arterial pressure and pulsatile flow in the organs. Today, the approved test for measuring vascular age is pulse wave velocity, which has been proven to predict cardiovascular events. Furthermore, vascular phenotypes, such as early vascular aging and "SUPERNOVA," representing phenotypic extremes of vascular aging, have been found. The identification of these phenotypes opens a new field of study in cardiovascular physiology. Lifestyle interventions and pharmacological therapy have positively affected vascular health, reducing arterial stiffness. This review aims to define the concepts related to vascular age, pathophysiology, measurement methods, clinical signs and symptoms, and treatment.

Keywords: aging; arterial stiffness; cardiovascular diseases; pulse wave analysis; risk factors; vascular age; vascular stiffness.

Figure 1

Factors involved in the pathophysiology of VAg. The figure shows the factors involved in the pathogenesis of vascular aging, grouped by etiology as molecular, epigenetic, genetic, and cellular. DNA, deoxyribonucleic acid; ET-1, endothelin 1; RAAS, renin–angiotensin–aldosterone system; ECM, extracellular matrix; VSMC, vascular smooth muscle cell; SASP, senescence-associated secretory phenotype.

Figure 2

Structural changes in atherosclerotic arteries and their relationship with vascular stiffness. Structural changes in arteries undergoing an arteriosclerotic process, showing their ability to adapt and the structural plaque changes. Over time, there is negative vascular remodeling, affecting the lumen. The dotted lines show changes in the vessel area over time and changes in the luminal area due to vascular remodeling. PMN, polymorphonuclear neutrophils; LDL, low-density lipoprotein; VSMC, vascular smooth muscle cell.

Figure 3

Vascular age phenotypes. A graphic representation of the vascular age phenotypes. In the EVA phenotype, individuals have elevated cf-PWV at an early age, while in the SUPERNOVA phenotype, older patients have a lower cf-PWV, despite having risk factors. EVA, early vascular aging; CVD, cardiovascular disease; CVR, cardiovascular risk; RFs, risk factors; AS, arterial stiffness.

Figure 4

Arterial remodeling in the vascular aging phenotypes. A diagram of the different types of arterial remodeling with normal aging. The proximal large elastic arteries, such as the thoracic aorta, carotids, and abdominal aorta, enlarge (eccentric remodeling) and become stiffer with aging, while the distal medium-sized muscular arteries do not enlarge with age and their distensibility does not change. In both places, normal aging is associated with medial hypertrophy (hypertrophic remodeling). The EVA phenomenon is accompanied by a reduction in the lumen diameter and is associated with an increased media/lumen (M/L) ratio. With supernormal vascular aging (SUPERNOVA), the vascular area increases.

Figure 5

Theoretical correlation between the number of lifestyle habits and vascular age. A diagram of the theoretical relationship between the eight essential health habits recommended by the American Heart Association (81) and their impact on people's vascular age. The X axis shows the vascular age in years, and the Y axis shows the person's number of habits. A higher number of healthy habits are correlated with a lower vascular age. Icons adapted from Canva by authors licensed for use according to a Canva for Education license.