Accelerated Vascular Ageing: An Early Prognostic Signal for Risk Stratification and Prevention

Vascular ageing develops across the life course and contributes to cardiovascular, renal, cognitive, and pregnancy-related disease. It reflects cumulative exposure to pulsatile haemodynamic stress acting on the arterial wall and biological processes leading to arterial stiffening. This review integrates evidence from arterial mechanics, vascular biology, clinical epidemiology, diagnostic science, and health economics to examine how vascular ageing can be measured, interpreted, and translated into prevention. When arterial ageing progresses faster than expected for chronological age, biomarkers reflecting arterial stiffness, central pressures, and wave reflection indices consistently predict adverse outcomes independently of brachial blood pressure, often preceding overt disease. Although lifestyle and pharmacologic interventions can modify functional vascular tone and central haemodynamic load, durable modification of structural arterial stiffening remains limited, reinforcing the importance of early detection. Despite a robust prognostic signal, clinical adoption has been constrained by fragmented biomarkers, heterogeneous measurement approaches, and absence of outcome-based decision pathways. Current guidelines recognise vascular biomarkers as indicators of organ damage and modifiers of risk, but do not provide explicit algorithms linking measurement to management. Evidence supports targeted assessment in intermediate-risk and clinically ambiguous populations, where results may inform treatment intensification, therapeutic selection, and monitoring. Composite vascular ageing metrics offer a pathway to integrate complementary haemodynamic signals, but their incremental value over established measures such as pulse wave velocity remains uncertain and may introduce risks of oversimplification. Progress requires harmonised measurement, outcome-anchored thresholds, and integration of clinical and economic evidence to support earlier and more effective prevention.