Vascular ageing

The health of your arteries determines how efficiently blood will flow, as arteries transport oxygenated blood throughout your body. Blockages from plaque build-up seen with atherosclerosis, is a common disorder affecting blood flow. However, the integrity or soundness of blood vessel walls are just as important to the fluidity of blood movement and the proficient transference of nutrients and oxygen from the blood stream into your organs.

As we age, arteries begin to deteriorate, affecting their structure and function. These changes over time can predict cardiovascular events and mortality. Variations occur to the elasticity and density of all the different types of arteries in the body including the aorta. Vessels gradually become stiffer and thicker over the course of our lifetime, and as the global population are living longer, also referred to as the ‘era of ageing’, the health effects associated with these changes are becoming more profound.

The World Health Organization found that the number of people aged 60 years old was around 1.4 billion in 2020, with the number surpassing 2.1 billion in the next 30 years. Among the non-communicable diseases, vascular disorders (eg. coronary heart disease, stroke and heart failure) are responsible for approximately 44% of mortality among the elderly. Study reviews have found that these vascular diseases are shown to have contributed to 3.8 million deaths in Europe with 65% occurring in people aged 75+ years. These statistics demonstrate the vital importance of understanding the pathogenesis of age-related vascular disorders to help improve health and longevity among the increasing elderly population.

Vascular ageing is described or distinguished by arterial and capillary stiffness however the process is very complex and multifaceted. Included among the mechanisms and other health conditions involved with vascular ageing are:

  • Endothelial dysfunction. Endothelial cells control the flow of fluid into and out of a tissue and line blood vessels.
  • Oxidative stress (OS) and overproduction of reactive oxygen species (ROS) also known as free radicals. Visit our website for information about OS and ROS.
  • Impaired angiogenesis (growth of blood vessels) capacity.
  • Atherosclerosis.
  • Chronic inflammation.
  • The accumulation of senescent cells in the vasculature. Senescence is referred to as the ‘process of growing old’ where cells age and stop dividing, however do not die. As we get older senescent cells increase in numbers and build up in tissues.
  • Mitochondrial dysfunction. Mitochondria are found inside cells and their function is to generate most of the chemical energy needed to power the cell's biochemical reactions.

The function of the large arteries is to reduce the pulsatility or rhythmic pulsing of cardiac contraction by elastic recoiling after systolic expansion. This is important to ensure constant, regular blood flow is directed to tissues and organs.

However, as we get older, this buffering or protective effect is lost as the aorta and the main aortic branches begin to stiffen. The deterioration of the blood vessel walls also affects the smaller delicate microvascular vessels such as capillaries which can have an impact on the exchange of oxygen and nutrients to vital organs.

Consequences to cardiovascular health, associated with alterations to the elasticity and stiffness of arteries include:

  • Elevated pulse pressure and the development of isolated systolic hypertension.
  • An increase in left ventricular late systolic afterload. This can lead to ventricular re-modelling and hypertrophy, diastolic dysfunction, impaired exercise capacity, and, over time, an increased risk of new-onset heart failure.
  • Lower diastolic blood pressure – leading to a reduction in coronary perfusion pressure and an increase in the risk of coronary events.
  • Increased transmission of elevated pulsatile pressure/flow to the micro-vasculature of target organs.

Women, blood pressure and arterial stiffness

A recent community-based study comprising women and men aged in their mid 40s had their blood pressure tested in 1992–1993 (baseline) and then at follow-up between 2018–2021. The categories tested were non-elevated BP (< 120/70 mmHg), elevated BP (120–139/70–89 mmHg), and hypertension (≥ 140/90 mmHg) in early midlife. The presence of arterial stiffness was tested at follow-up. Results showed that women who had an elevated BP in midlife had twice the risk, and those with hypertension had four times the risk of increased arterial stiffness compared with women with non-elevated BP later in life. This association was not found in men.

Healthy vasculature

Data from 2023 found that there is approximately only 1% of the population over the age of 70 that maintain normal vascular function. This demonstrates the vital need to understand the relevant biomarkers and causal factors associated with vascular deterioration as we age.

Healthy vascular ageing is the result of several interrelated determinants – genetics, diet, exercise and social support. Research has shown that there are some modifiable risk factors which can play a role in supporting and maintaining blood vessels.

Aerobic exercise and resistance training

  • Reduces carotid–femoral pulse wave velocity due to decreased inflammation and oxidative stress; reduces collagen deposits.
  • It has also shown to reduce the formation of advanced glycation end (AGEs) products (harmful compounds formed from the combination of protein or fat with sugar in the bloodstream) in the arterial wall. AGEs have been linked to inflammation, heart disease and oxidative stress.
  • A sedentary lifestyle has been associated with atherosclerosis and arterial wall stiffening, enabled by oxidative stress.

Caloric restriction and reduction of sodium intake

  • Significantly decreases carotid–femoral pulse wave velocity via the reduction in ROS formation in the vascular wall.
  • Limiting the intake of fructose-based sweeteners has shown positive outcomes. Elevated levels activate xanthine oxidase-mediated oxidative stress, compromising endothelial function and encouraging arterial stiffening. Examples of food items containing high amounts of fructose include sweetened beverages, fruit juices, soft drinks, grape juice, cranberry juice and corn syrup.
  • It is recommended to increased intake of fruit and vegetables as they are shown to be rich in vasculo-protective phytochemicals and minerals.

References

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Author: Gina Rodgers

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