Vascular aging and cardiovascular disease: pathophysiology and measurement in the coronary arteries

Daniel C Y Cheng; Rachel E Climie; Matthew Shu; Stuart M Grieve; Rebecca Kozor; Gemma A Figtree

doi:10.3389/fcvm.2023.1206156

Vascular aging and cardiovascular disease: pathophysiology and measurement in the coronary arteries

Front Cardiovasc Med. 2023 Nov 28:10:1206156. doi: 10.3389/fcvm.2023.1206156. eCollection 2023.

Authors

Daniel C Y Cheng¹, Rachel E Climie², Matthew Shu³, Stuart M Grieve^{1

4}, Rebecca Kozor^{1

5}, Gemma A Figtree^{1

4

5}

Affiliations

¹ Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia.
² Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
³ Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
⁴ Imaging and Phenotyping Laboratory, Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
⁵ Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia.

Abstract

Age is a key risk factor for cardiovascular disease, including atherosclerosis. However, pathophysiological disease processes in the arteries are not an inevitable feature of aging. Large cohort studies with arterial phenotyping along with clinical and demographic data are essential to better understand factors related to the susceptibility or resilience to age-related vascular pathophysiology in humans. This review explores the mechanisms by which vascular structure and function alters with age, and how these changes relate to cardiovascular pathophysiology and disease. Features of vascular aging in the coronary arteries have historically been difficult to quantify pre-mortem due to their size and location. However, non-invasive imaging modalities including CT Coronary Angiogram are now being used to assess coronary vascular age, and further advances in imaging analysis such as the CT Fat Attenuation Index will help provide further measurement of features associated with coronary vascular aging. Currently, markers of vascular aging are not used as therapeutic targets in routine clinical practice, but non-pharmacological interventions including aerobic exercise and low salt diet, as well as anti-hypertensives have been demonstrated to reduce arterial stiffness. Advances in imaging technology, both in acquisition and advanced analysis, as well as harmonisation of measurements for researchers across the globe will be invaluable in understanding what constitutes healthy vascular aging and in identifying features of vascular aging that are associated with coronary artery disease and its adverse outcomes. Assessing such images in large cohorts can facilitate improved definitions of resilient and susceptible phenotypes to vascular aging in the coronary arteries. This is a critical step in identifying further risk factors and biomarkers within these groups and driving forward the development of novel therapies aimed at slowing or stopping age-related vascular changes in the coronary arteries.

Keywords: cardiovascular imaging; coronary artery disease; healthy vascular aging; vascular aging.

Publication types

Review

Grants and funding

GF is supported by a National Health and Medical Research Council Practitioner Fellowship (GNT11359290), Heart Research Australia, and the New South Wales Office of Health and Medical Research. SG is supported by the Parker-Hughes Bequest, the New South Wales Office of Health and Medical Research, and the Frecker Family. RC is supported by the National Health and Medical Research Council of Australia (reference: 2009005) and by a National Heart Foundation Future Leader Fellowship (reference: 105636).