Do Arteries Have a Biological Age? How the Vascular System Changes Over Time and When to Get It Checked

The biological age of the arteries does not refer to a specific chronological age, but rather to the health of the blood vessels, particularly their:

• elasticity;
• function;
• structural integrity.

Healthy arteries are elastic structures capable of adapting to changes in blood pressure and to the body's physiological needs. With age, it is normal for them to become progressively stiffer; however, this process can be accelerated by certain risk factors.

Factors that may contribute to accelerated vascular ageing include:

• cigarette smoking;
• uncontrolled high blood pressure;
• diabetes mellitus;
• high cholesterol levels;
• physical inactivity;
• a family history of cardiovascular disease.

When arterial stiffening and other vascular changes occur more rapidly than would normally be expected for a person's age, this is referred to as early vascular ageing.

“Arteries do not all age in the same way. In some patients, deterioration progresses slowly and is consistent with normal ageing, while in others it may be accelerated by risk factors that are not adequately controlled. The aim of prevention is to identify these changes before they become clinically significant,” explains Dr Mainente.

Arterial ageing is a complex process resulting from the interaction between individual characteristics, health conditions and everyday habits. The main factors that may contribute to the development of vascular changes include:

• cigarette smoking;
• persistently high blood pressure;
• abnormalities in lipid metabolism and blood glucose regulation;
• chronic low-grade inflammation;
• low levels of physical activity;
• an unbalanced diet;
• family predisposition.

These factors may promote progressive changes in the arterial wall, reducing vascular elasticity and potentially increasing the risk of cardiovascular disease.

Young people can also show signs of vascular abnormalities, particularly when several risk factors are present at the same time. For this reason, assessment of arterial health should not be based solely on chronological age.

Arterial abnormalities can remain silent for a long time. In the early stages, many vascular conditions do not cause obvious symptoms. However, certain signs warrant specialist assessment:

• pain or cramping in the legs while walking, particularly if it improves with rest;
• a feeling of coldness in the lower limbs;
• reduced ability to perform usual physical activities;
• changes in sensation or in the skin of the limbs;
• difficulty controlling blood pressure.

“One of the most important aspects of clinical practice is not to underestimate cardiovascular risk factors, even when they are present in young patients or in people who appear to be in good health. Vascular changes can develop slowly and remain silent for years,” Dr Mainente emphasises.

A vascular assessment combines:

• specialist consultation;
• evaluation of risk factors;
• diagnostic tests, when indicated.

The most commonly used investigations include arterial and venous colour Doppler ultrasound, a non-invasive examination that assesses blood flow and the characteristics of the blood vessels, and blood tests to evaluate parameters associated with cardiovascular risk, such as blood glucose and the lipid profile.

These tools can help identify vascular abnormalities even before significant symptoms develop and allow a personalised prevention strategy to be defined.

Arterial ageing is a natural process, but many of the factors that can accelerate it are modifiable risk factors.

Preserving vascular health therefore means first and foremost addressing these risk factors through:

• smoking cessation;
• regular blood pressure monitoring;
• management of cholesterol and blood glucose levels;
• regular physical activity;
• a balanced diet;
• specialist follow-up for people at increased risk.

The goal of prevention is not only to prevent disease, but also to preserve cardiovascular function over time.

An angiology assessment may be appropriate not only when symptoms are present, but also for people with:

• cardiovascular risk factors;
• a family history of vascular disease;
• conditions that may contribute to accelerated arterial ageing.

Early diagnosis makes it possible to identify initial abnormalities and develop targeted strategies to reduce the risk of progression to more complex conditions, such as peripheral arterial disease or other cardiovascular complications.

At Istituto Clinico San Siro, the vascular health pathway combines specialist assessment, diagnostic imaging and definition of the most appropriate treatment plan for each patient.

The Angiology and Vascular Surgery Service, headed by Dr Andrea Mainente, provides diagnosis and management of arterial and venous diseases through a personalised approach that may include clinical monitoring, medical therapy, minimally invasive procedures or surgery, when indicated.

Vascular prevention begins with understanding the health of your arteries. Identifying abnormalities at an early stage allows timely intervention and helps preserve cardiovascular function over time.