Normal circulatory function is a key determinant of disease-free life expectancy (healthspan). Indeed, pathologies affecting the cardiovascular system, which are growing in prevalence, are the leading cause of global morbidity, disability and mortality, whereas the maintenance of cardiovascular health is necessary to promote both organismal healthspan and lifespan. Therefore, cardiovascular ageing might precede or even underlie body-wide, age-related health deterioration. In this Review, we posit that eight molecular hallmarks are common denominators in cardiovascular ageing, namely disabled macroautophagy, loss of proteostasis, genomic instability (in particular, clonal haematopoiesis of indeterminate potential), epigenetic alterations, mitochondrial dysfunction, cell senescence, dysregulated neurohormonal signalling and inflammation. We also propose a hierarchical order that distinguishes primary (upstream) from antagonistic and integrative (downstream) hallmarks of cardiovascular ageing. Finally, we discuss how targeting each of the eight hallmarks might be therapeutically exploited to attenuate residual cardiovascular risk in older individuals.
Age is one of the strongest determinants of cardiovascular health.
The cardiovascular system operates under constant mechanical and metabolic stress, which progressively increases the risk of dysfunction at the molecular, cellular and whole-organ levels with increasing age.
Disabled macroautophagy, loss of proteostasis, genomic instability, epigenetic alterations, mitochondrial dysfunction, cell senescence, dysregulated neurohormonal signalling and inflammation emerge as common molecular hallmarks of cardiovascular ageing.
The hallmarks of cardiovascular ageing are strongly intertwined, and accentuation or attenuation of individual hallmarks affects most, if not all, the others.
Targeting the hallmarks of cardiovascular ageing holds promise for the treatment of major cardiovascular disorders and to reduce residual cardiovascular risk beyond the management of conventional risk factors.
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