Vascular Aging and Cardiovascular Disease

As our knowledge on the field increases, so does our understanding of the pathophysiology of vascular aging. Since our last edition, many new contributors to (and models of) vascular aging have surfaced, bringing several new details to the discussion. When reviewing this chapter we integrated these developments with what was already known. Bearing in mind the distinctive role of age in the development of cardiovascular disease, a three-step approach was used in this chapter. Firstly, we summarize the main structural and functional changes that the vascular system undergoes with increasing chronological age which leads to four landmark changes associated with development of cardiovascular disease: arteriosclerosis, changes in pulse wave reflection, loss of the impedance mismatch between macro- and microcirculation, and the influence of accelerators of aging on development of atherosclerosis. Secondly, early recognition of subjects with an accelerated aging process is revisited from a clinical stand point by debating useful techniques and algorithms to measure arterial damage, and define early vascular aging with the ultimate goal being a more accurate cardiovascular risk attribution. Finally, the association of several central hemodynamic measures with cardiovascular risk is revisited with a focus on existing evidence and ongoing or future research opportunities.