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Introduction
Cardiovascular disease (CVD) is the leading cause of mortality worldwide, accounting for 38% of premature deaths below the age of 70 years [1]. Over the last 30 years, premature death due to CVD has been increasing, highlighting the ongoing importance of research in the field to understand how to determine cardiovascular status as well as the study of underlying pathophysiological mechanisms to improve outcomes through the development of prevention and treatment strategies [2].
Early vascular ageing (EVA) is defined as the presence of accelerated age-related changes in blood vessels, whereby the structure or function of the vessels resemble a more advanced biologic age than chronologic age, due to a series of characteristic changes (Table 1) [3]. EVA is a recognised independent risk factor for CVD and can be responsible for premature mortality with cardiovascular aetiology [4]. EVA can develop secondary to environmental and social exposures (air pollution, poverty, smoking, obesity, lack of exercise) as well as personal medical risk factors (hypertension, diabetes, genetic factors). Accumulation of subclinical vascular changes directs an individual towards a trajectory of EVA, with the potential to occur even in early fetal life, influencing future adult disease risk [5, 6]. Importantly, EVA changes can be reversible if interventions are implemented at an early stage, thus identifying people at risk and developing strategies for timely detection is crucial [7, 8].
Table 1. Features which characterise early vascular ageing (EVA)
Type of change | Characteristic feature of EVA |
|---|---|
Change in macrovascular structure | Reductions in networks of collateral vessels Decreased number of arterioles Decreased number of arteriolar anastomoses Shorter, more fragmented elastin fibres Increased collagen cross-linking Reduced collagen elasticity Loss of capillaries |
Change in morphology | Increased wall thickness Hypertrophy particularly in the tunica media layer and in the tunica intima via infiltration of migrating vascular smooth muscle cells |
Change in function | Increased vascular stiffness Reduced elasticity and compliance of the vessel wall Increased vascular resistance Reduced vascular contractility |
The pathognomonic changes of EVA in the vasculature have been studied on an experimental basis in blood vessels, however, these specimens are obtained by invasive procedures and thus are not practical for routine use in clinical practice to determine those at risk of EVA and premature CVD. As such, it is clear that there is a...