Cardiovascular ageing definition: a scoping review on conceptual and operational frameworks

Cardiovascular ageing involves changes such as arterial stiffening, myocardial remodelling, and systemic inflammation, which are linked to health decline, disease, and mortality. Despite advancements in understanding these mechanisms, establishing a concise and joined definition of cardiac and vascular ageing remains challenging. In this scoping review, we describe the key conceptual and operational definitions of cardiovascular ageing and propose a conceptual framework for understanding and defining the process. Current literature defines vascular ageing as the decline in arterial function and structure. Early vascular ageing refers to an accelerated deterioration, whereas healthy vascular ageing or supernormal vascular ageing describes individuals with exceptionally favourable vascular profiles. Key biomarkers for vascular ageing include pulse wave velocity measurements and carotid intima-media thickness, though definitions and cut-offs vary. In the context of cardiac ageing, NT-proBNP, high-sensitivity C-reactive protein, and high-sensitivity cardiac troponin T are highlighted for their potential to enhance risk prediction and clinical management. Combining these measurements into a comprehensive cardiovascular ageing score could provide more comprehensive assessments of cardiovascular health. Future research should aim to validate these definitions and biomarkers across diverse populations to establish robust reference values, refine prediction models, and improve the early identification and intervention of individuals at risk. Improving our ability to measure and understand cardiovascular ageing will enable us to better identify at-risk individuals and implement targeted interventions to mitigate cardiovascular risks early in the lifespan.