Mechanisms of Vascular Aging

OCT-Based Retinal Vasculature Analysis: Age, Sex, and Body Mass Index Associations in the Nagahama Study, a Large Japanese Cohort

Objective

This study aimed to evaluate retinal vessel structure using OCT, which enables high-resolution imaging for detailed vascular assessment. We investigated how age, sex, and body mass index (BMI) influence the OCT-measured parameters, including outer and inner diameters (ODs and IDs, respectively), wall thickness, and wall reflectivity-parameters that are challenging to assess using color fundus photography.

Design

A cross-sectional retrospective study.

Participants

The study included 6981 participants in the Nagahama Study, with 6981 eyes being assessed.

Methods

OCT B-scan images centered on the optic disc were obtained. For each participant, mean values of the ODs and IDs, wall thickness, and wall reflectivity of the 4 largest arteries and veins were measured.

Main Outcome Measures

Associations of retinal vessel parameters with age, sex, and BMI were evaluated. The reliability of OCT-measured parameters was assessed using intraclass correlation coefficients. Multivariable linear regression adjusted for intraocular pressure and axial length was used to investigate the associations with demographic and anthropometric factors.

Results

Intraclass correlation coefficients for retinal vessel parameters demonstrated good-to-excellent reliability (0.767-0.957, P < 0.001). Compared with those of veins, arterial diameters were smaller, and arterial wall thickness and reflectivity were greater. Multivariable analysis revealed a U-shaped association between age and arterial diameter. Participants aged ≥60 years had significantly larger diameters than those aged 30 to 40 years and those in their 50s. Venous diameter decreased linearly with age. The arterial wall thickness and reflectivity increased with age. Women exhibited larger arterial diameters than men. Body mass index was negatively associated with the arterial diameter and positively associated with the venous diameter and arterial wall thickness.

Conclusions

OCT enabled detailed evaluation of retinal vessel structure, allowing for the measurement of parameters that are challenging to assess by fundus photography, such as IDs and ODs, wall thickness, and wall reflectivity. This study, conducted in a large Japanese cohort, demonstrated significant associations between these OCT-measured retinal vascular parameters and age, sex, and BMI. These findings support the potential of OCT as a valuable tool for objective, in-depth assessment of retinal vascular health and its relationships with demographic and anthropometric factors.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Vascular and glymphatic dysfunction as drivers of cognitive impairment in Alzheimer's disease: Insights from computational approaches

Alzheimer's disease (AD) is driven by complex interactions between vascular dysfunction, glymphatic system impairment, and neuroinflammation. Vascular aging, characterized by arterial stiffness and reduced cerebral blood flow (CBF), disrupts the pulsatile forces necessary for glymphatic clearance, exacerbating amyloid-beta (Aβ) accumulation and cognitive decline. This review synthesizes insights into the mechanistic crosstalk between these systems and explores their contributions to AD pathogenesis. Emerging machine learning (ML) tools, such as DeepLabCut and Motion sequencing (MoSeq), offer innovative solutions for analyzing multimodal data and enhancing diagnostic precision. Integrating ML with imaging and behavioral analyses bridges gaps in understanding vascular-glymphatic dysfunction. Future research must prioritize these interactions to develop early diagnostics and targeted interventions, advancing our understanding of neurovascular health in AD.

The Role of NAD+ Metabolism in Cardiovascular Diseases: Mechanisms and Prospects

Nicotinamide adenine dinucleotide (NAD+) is a promising anti-aging molecule that plays a role in cellular energy metabolism and maintains redox homeostasis. Additionally, NAD+ is involved in regulating deacetylases, DNA repair enzymes, inflammation, and epigenetics, making it indispensable in maintaining the basic functions of cells. Research on NAD+ has become a hotspot, particularly regarding its potential in cardiovascular disease (CVD). Many studies have demonstrated that NAD+ plays a crucial role in the occurrence and development of CVD. This review summarizes the biosynthesis and consumption of NAD+, along with its precursors and their effects on raising NAD+ levels. We also discuss new mechanisms of NAD+ regulation in cardiovascular risk factors and its effects of NAD+ on atherosclerosis, aortic aneurysm, heart failure, hypertension, myocardial ischemia-reperfusion injury, diabetic cardiomyopathy, and dilated cardiomyopathy, elucidating different mechanisms and potential treatments. NAD+-centered therapy holds promising advantages and prospects in the field of CVD.

Fisetin Clears Senescent Cells Through the Pi3k-Akt-Bcl-2/Bcl-xl Pathway to Alleviate Diabetic Aortic Aging

Vascular aging is a major contributor to age-related cardiovascular diseases (CVDs) and type 2 diabetes mellitus (T2DM) induced early arterial aging and excessive senescent cells (SCs) burden in vessels. Inhibiting cellular senescence or eliminating SCs could effectively improve aging-related CVDs. Fisetin, a flavonoid extracted from cotinus coggygria scop, has shown potential in alleviating aging by clearing SCs. This study investigated the unexplored mechanisms and efficacy of fisetin in alleviating T2DM-related aortic aging. The T2DM mouse model was induced using a high-fat diet and low-dose streptozotocin injection. Chronic fisetin treatment's protective effects against aortic aging were assessed via senescence-associated beta-galactosidase (SA-β-Gal) staining, histopathology, and vasomotor function. RNA-sequencing and western blotting identified relevant signaling pathways and protein expression. Fisetin's effects on SCs and senescence-associated secretory phenotype (SASP) factors were evaluated through cell viability, apoptosis, and co-culture assays. Docking simulations suggested fisetin as a potential Phosphoinositide 3-kinase (Pi3k) inhibitor. In vivo, chronic fisetin treatment reduced aortic SCs burden, alleviating T2DM-related and natural aortic aging. In vitro, fisetin selectively induced apoptosis of senescent endothelial cells via regulating the Pi3k-Protein Kinase B (Akt)-B-cell lymphoma (Bcl)-2/Bcl-xl pathway and suppressed SASP and its detrimental effects. Furthermore, fisetin combined with metformin therapy showed superior anti-aging effects on T2DM-related aortic aging compared to metformin monotherapy. In conclusion, chronic fisetin treatment alleviates T2DM-related aortic aging via clearing the SCs burden and abrogating the SASP factors. Fisetin combined with metformin therapy might be a potential therapeutic strategy for T2DM-related CVDs.

Mitochondrial Dysfunction: A New Hallmark in Hereditable Thoracic Aortic Aneurysm Development

Thoracic aortic aneurysms (TAAs) pose a significant health burden due to their asymptomatic progression, often culminating in life-threatening aortic rupture, and due to the lack of effective pharmacological treatments. Risk factors include elevated hemodynamic stress on the ascending aorta, frequently associated with hypertension and hereditary genetic mutations. Among the hereditary causes, Marfan syndrome is the most prevalent, characterized as a connective tissue disorder driven by FBN1 mutations that lead to life-threatening thoracic aortic ruptures. Similarly, mutations affecting the TGF-β pathway underlie Loeys-Dietz syndrome, while mutations in genes encoding extracellular or contractile apparatus proteins, such as ACTA2, are linked to non-syndromic familial TAA. Despite differences in genetic origin, these hereditary conditions share central pathophysiological features, including aortic medial degeneration, smooth muscle cell dysfunction, and extracellular remodeling, which collectively weaken the aortic wall. Recent evidence highlights mitochondrial dysfunction as a crucial contributor to aneurysm formation in Marfan syndrome. Disruption of the extracellular matrix-mitochondrial homeostasis axis exacerbates aortic wall remodeling, further promoting aneurysm development. Beyond its structural role in maintaining vascular integrity, the ECM plays a pivotal role in supporting mitochondrial function. This intricate relationship between extracellular matrix integrity and mitochondrial homeostasis reveals a novel dimension of TAA pathophysiology, extending beyond established paradigms of extracellular matrix remodeling and smooth muscle cell dysfunction. This review summarizes mitochondrial dysfunction as a potential unifying mechanism in hereditary TAA and explores how understanding mitochondrial dysfunction, in conjunction with established mechanisms of TAA pathogenesis, opens new avenues for developing targeted treatments to address these life-threatening conditions. Mitochondrial boosters could represent a new clinical opportunity for patients with hereditary TAA.

Understanding Cognitive Decline in Aging: Mechanisms and Mitigation Strategies - A Narrative Review

Cognitive decline is a natural process that accompanies aging. In some cases, such as in sarcopenia-burdened or diseased older adults, the disease course may be more rapid. Declining cognitive function is associated with changes in the central nervous system per se or peripheral triggers that impair cognition. This review discusses issues related to central, central-peripheral, and peripheral factors that enhance cognitive deterioration, such as cortical thickness, cerebral white matter structure and function, blood-brain barrier (BBB) disruption, insulin resistance, inflammation, and vascular dysfunction. BBB permeability appears to be a critical point for factors associated with aging that may accelerate cognitive decline. Thus, we provide an in-depth analysis of the central-peripheral crosstalk. Additionally, we discuss high-intensity interval training (HIIT) as a promising strategy to counteract changes that accompany the aging process. Resistance (RHIIT) and aerobic (AHIIT) may be beneficial for cognitive health among the elderly, but their lack of empirical confirmation is a huge gap in the research.

Effect of structural changes of Rehmannia glutinosa polysaccharide before and after processing on anti-aging activity

Rehmannia glutinosa is often used to delay aging in traditional Chinese medicine (TCM). The processing methods utilized in TCM can enhance its anti-aging properties. Polysaccharides are the primary active constituents of R. glutinosa. Against this background, this study aims to investigate the alterations in polysaccharide structure before and after the processing of R. glutinosa, as well as the correlation between aging activity and polysaccharide structure. In this paper, Rehmanniae Radix polysaccharide (RGP50-2) and Rehmanniae Radix Praeparata(SDP50-2) were purified from R. glutinosa before and after processing. Structural analysis showed that compared with RGP50-2, the molecular weight of SDP50-2 (9.8-9.6 kDa) decreased, and the content of Ara (22.5 %-55.49 %) increased. NMR results show that the main chains of RGP50-2 and SDP50-2 are both →6)-β-Galp-(1→, →3,4,6)-α-Galp-(1→ and →2,3,5)-α-Araf-(1→, but the branching degree of SDP50-2 is lower. Pharmacological assessments showed that SDP50-2 had superior anti-aging activity over RGP50-2 by modulating the IIS signaling pathway. In conclusion, processing significantly alters the chemical structure of R. glutinosa polysaccharides, enhancing their anti-aging efficacy. Our research provides a theoretical framework and a reference for optimizing processing techniques and advancing development strategies for R. glutinosa polysaccharides.

Hydrogen sulfide preserves the function of senescent endothelium through SIRT2 mediated inflammatory inhibition

Endothelial aging is an independent risk factor of cardiovascular diseases, and this study aims to explore the mechanism of endothelial aging. We first applied two animal aging models and two cellular aging models to observe the characteristics of senescent endothelium at the morphological, functional, and molecular levels. It was confirmed that the aging of endothelial cells was accompanied by activation of Nod like receptor protein 3 (NLRP3) inflammasome pathway, reduced levels of hydrogen sulfide (H2S) and sirtuin2 (SIRT2) activity. Endothelial specific knockout of cystathionine-γ-lyase (CSE) led to premature aging of blood vessels, and excessive activation of the SIRT2/NLRP3 inflammasome. Finally, H2S supplementation improved vascular and endothelial cell function, normalized inflammatory cytokine levels, and thereby reversed endothelial aging through SIRT2/NLRP3 mediated pathway. In this study, we found that the decrease in SIRT2 activity in aging endothelial cells increased the level of NLRP3 inflammasome and H2S inhibited inflammation to improve endothelial aging through the SIRT2/NLRP3 pathway. This provided H2S could be a new target for improving endothelial aging, and offered new strategies for defending human aging.

Endothelial IGF- 1R deficiency disrupts microvascular homeostasis, impairing skeletal muscle perfusion and endurance: implications for age-related sarcopenia

Aging is associated with a progressive decline in circulating insulin-like growth factor- 1 (IGF- 1) levels in humans, which has been implicated in the pathogenesis of sarcopenia. IGF- 1 is an anabolic hormone that plays a dual role in maintaining skeletal muscle health, acting both directly on muscle fibers to promote growth and indirectly by supporting the vascular network that sustains muscle perfusion. However, the microvascular consequences of IGF- 1 deficiency in aging muscle remain poorly understood. To elucidate how impaired IGF- 1 input affects skeletal muscle vasculature, we examined the effects of endothelial-specific IGF- 1 receptor (IGF- 1R) deficiency using a mouse model of endothelial IGF- 1R knockdown (VE-Cadherin-CreERT2/Igf1rf/f mice). These mice exhibited significantly reduced skeletal muscle endurance and attenuated hyperemic response to acetylcholine, an endothelium-dependent vasodilator. Additionally, they displayed microvascular rarefaction and impaired nitric oxide-dependent vasorelaxation, indicating a significant decline in microvascular health in skeletal muscle. These findings suggest that endothelial IGF- 1R signaling is critical for maintaining microvascular integrity, muscle perfusion, and function. Impaired IGF- 1 input to the microvascular endothelium may contribute to reduced muscle blood flow and exacerbate age-related sarcopenia. Enhancing vascular health by modulating IGF- 1 signaling could represent a potential therapeutic strategy to counteract age-related muscle decline.

Circadian rhythm gene cryptochrome 2 (Cry2) interacts with lipid metabolism to promote vascular aging

BACKGROUND

Vascular aging is the basis of many chronic diseases of the aged, such as hypertension, coronary heart disease and stroke.

OBJECTIVE

This study aims to deepen our understanding of the pathological mechanisms of vascular aging by combining multiple big data research methods, and reveal potential therapeutic targets and biomarkers.

METHODS

WGCNA method was used to integrate the aortic transcriptome data of multiple age stages, and extract the key module and key pathway. The gene of aortic rhythm was integrated by JTK algorithm. Correlation calculation was performed for core gene and associated pathways. Finally, the expression of the core gene and their interaction with the associated pathways were verified in cell senescence.

RESULTS

WGCNA showed that circadian rhythm is the key pathway of vascular aging, and circadian rhythm and metabolism interact to promote the occurrence of vascular aging. Cry2 has been identified as the most critical core rhythm gene. Lipid metabolism is the most Cry2-related subpathway, among which phospholipid metabolism and Serac1 have the strongest and most significant correlation with Cry2. Cry2 is mainly distributed in endothelial cells in both young and senescent blood vessels, and affects five lipid-related metabolic processes including lipid transport during endothelial senescence.

CONCLUSION

This study suggests that circadian rhythm and Cry2 may be potential targets of vascular aging, and further studies on their interaction with lipid metabolism will provide effective strategies for the prevention and treatment of age-related vascular diseases.

Crosstalk between endothelial cells and dermal papilla entails hair regeneration and angiogenesis during aging

INTRODUCTION

Tissues maintain their function through interaction with microenvironment. During aging, both hair follicles and blood vessels (BV) in skin undergo degenerative changes. However, it is elusive whether the changes are due to intrinsic aging changes in hair follicles or blood vessels respectively, or their interactions.

OBJECTIVE

To explore how hair follicles and blood vessels interact to regulate angiogenesis and hair regeneration during aging.

METHODS

Single-cell RNA-sequencing (scRNA-seq) analyses were used to identify the declined ability of dermal papilla (DP) and endothelial cells (ECs) during aging. CellChat and CellCall were performed to investigate interaction between DP and ECs. Single-cell metabolism (scMetabolism) analysis and iPATH were applied to analyze downstream metabolites in DP and ECs. Hair-plucking model and mouse cell organoid model were used for functional studies.

RESULTS

During aging, distance and interaction between DP and ECs are decreased. DP interacts with ECs, with decreased EDN1-EDNRA signaling from ECs to DP and CTF1-IL6ST signaling from DP to ECs during aging. ECs-secreted EDN1 binds to DP-expressed EDNRA which enhances Taurine (TA) metabolism to promote hair regeneration. DP-emitted CTF1 binds to ECs-expressed IL6ST which activates alpha-linolenic acid (ALA) metabolism to promote angiogenesis. Activated EDN1-EDNRA-TA signaling promotes hair regeneration in aged mouse skin and in organoid cultures, and increased CTF1-IL6ST-ALA signaling also promotes angiogenesis in aged mouse skin and organoid cultures.

CONCLUSIONS

Our finding reveals reciprocal interactions between ECs and DP. ECs releases EDN1 sensed by DP to activate TA metabolism which induces hair regeneration, while DP emits CTF1 signal received by ECs to enhance ALA metabolism which promotes angiogenesis. Our study provides new insights into mutualistic cellular crosstalk between hair follicles and blood vessels, and identifies novel signaling contributing to the interactions of hair follicles and blood vessels in normal and aged skin.

Association of Vascular Aging Phenotypes with Adverse Clinical Outcomes in the Chinese Population: A Multicentre Study

Purpose

This study aimed to investigate the clinical implications of vascular aging (VAg) phenotypes based on the difference between chronological age (CA) and vascular age (VA).

Patients and Methods

We defined VA as the predicted age in a multivariable linear regression model including structural and functional parameters of arteries and conventional risk factors, in a multicentric, cross-sectional cohort (n=15580). According to the 10th and 90th percentiles of Δ-age (CA minus VA), we then classified the status of VAg into 3 phenotypes: the early VAg (EVA), the Normal VAg and the supernormal VAg (SUPERNOVA). We used Cox survival analysis to investigate the association between VAg phenotypes and the risk for adverse clinical outcomes (including all-cause death and cardiovascular disease) in an independent, prospective cohort (n=5316).

Results

In the prospective cohort (11.07 years, 927 events), when compared to the Normal VAg phenotype, EVA had an increased risk (HR: 2.43; 95% CI: 1.80-3.27) and SUPERNOVA had a decrease risk (HR: 0.75; 95% CI: 0.64-0.90) of adverse clinical outcomes, in particular stroke events. EVA also showed a higher risk of myocardial infarction (HR: 3.21, 95% CI: 1.56-6.62) and all-cause death (HR: 1.79, 95% CI: 1.12-2.85). The associations were independent of the atherosclerotic cardiovascular disease risk score. Further, the C-statistics increased 0.010 (P < 0.001), 0.013 (P < 0.001) and 0.016 (P < 0.001) separately when adding baPWV, adding the combination of baPWV and CIMT, and adding the VAg phenotypes to a model of conventional risk factors in predicting cardiovascular events.

Conclusion

This is the first study to evaluate the clinical implications of VAg phenotypes using multicentric data and undergone external validation in China. Our results emphasized that the classification of VAg phenotypes may be a potential tool to identify individuals who were susceptible to or resilient to VAg.

Deficiency of mitophagy mediator Parkin in aortic smooth muscle cells exacerbates abdominal aortic aneurysm

Abdominal aortic aneurysms (AAAs) are a degenerative aortic disease and associated with hallmarks of aging, such as mitophagy. Despite this, the exact associations among mitophagy, aging, and AAA progression remain unknown. In our study, gene expression analysis of human AAA tissue revealed downregulation of mitophagy pathways, mitochondrial structure, and function-related proteins. Human proteomic analyses identified decreased levels of mitophagy mediators PINK1 and Parkin. Aged mice and, separately, a murine AAA model showed reduced mitophagy in aortic vascular smooth muscle cells (VSMCs) and PINK1 and Parkin expression. Parkin knockdown in VSMCs aggravated AAA dilation in murine models, with elevated mitochondrial ROS and impaired mitochondrial function. Importantly, inhibiting USP30, an antagonist of the PINK1/Parkin pathway, increased mitophagy in VSMCs, improved mitochondrial function, and reduced AAA incidence and growth. Our study elucidates a critical mechanism that proposes AAAs as an age-associated disease with altered mitophagy, introducing new potential therapeutic approaches.

GPER1/ACACB are potential target genes associated with intracranial aneurysm and vascular endothelial cell senescence

The incidence of intracranial aneurysms (IAs) is markedly elevated in postmenopausal women compared to men and premenopausal women, a disparity historically linked to declining estrogen levels. Emerging evidence, however, suggests that the expression and functional roles of estrogen receptors (ERs), including ERα, ERβ, and GPER1, in vascular tissues may implicate estrogen-independent pathways in vascular aging and related pathologies. An integrative bioinformatics approach, combining three IA datasets (GSE75436, GSE122897, GSE54083) and two vascular endothelial cell senescence (VECS) datasets (GSE214476, GSE102397) from the Gene Expression Omnibus (GEO) database, was employed to investigate this hypothesis and define shared molecular mechanisms. This cross-disease differential expression analysis identified 452 significantly downregulated genes, suggesting conserved pathogenic pathways in IA and VECS. Among ERs, GPER1 was uniquely downregulated in both conditions. Subsequent weighted gene co-expression network analysis and subsequent module clustering revealed ACACB as a hub gene co-expressed with GPER1 and inversely correlated with IA and VECS progression. In vitro validation confirmed that GPER1 expression was reduced during VECS and that GPER1 silencing decreased ACACB expression and accelerated endothelial senescence, supporting its estrogen-independent role in vascular homeostasis. Computational pharmacological screening further identified PD0325901, SCH772984, and selumetinib as potential therapeutic agents targeting both GPER1 and ACACB, offering a dual-pathway therapeutic strategy. The identification of GPER1 and ACACB as potential target genes associated with IA and VECS provides a framework for developing therapies that circumvent hormone dependency, addressing an unmet need in the treatment of IA and age-related vascular pathologies.

Dissecting endothelial cell heterogeneity with new tools

The formation of a blood vessel network is crucial for organ development and regeneration. Over the past three decades, the central molecular mechanisms governing blood vessel growth have been extensively studied. Recent evidence indicates that vascular endothelial cells-the specialized cells lining the inner surface of blood vessels-exhibit significant heterogeneity to meet the specific needs of different organs. This review focuses on the current understanding of endothelial cell heterogeneity, which includes both intra-organ and inter-organ heterogeneity. Intra-organ heterogeneity encompasses arterio-venous and tip-stalk endothelial cell specialization, while inter-organ heterogeneity refers to organ-specific transcriptomic profiles and functions. Advances in single-cell RNA sequencing (scRNA-seq) have enabled the identification of new endothelial subpopulations and the comparison of gene expression patterns across different subsets of endothelial cells. Integrating scRNA-seq with other high-throughput sequencing technologies promises to deepen our understanding of endothelial cell heterogeneity at the epigenetic level and in a spatially resolved context. To further explore human endothelial cell heterogeneity, vascular organoids offer powerful tools for studying gene function in three-dimensional culture systems and for investigating endothelial-tissue interactions using human cells. Developing organ-specific vascular organoids presents unique opportunities to unravel inter-organ endothelial cell heterogeneity and its implications for human disease. Emerging technologies, such as scRNA-seq and vascular organoids, are poised to transform our understanding of endothelial cell heterogeneity and pave the way for innovative therapeutic strategies to address human vascular diseases.

Cerebromicrovascular senescence in vascular cognitive impairment: does accelerated microvascular aging accompany atherosclerosis?

Vascular cognitive impairment (VCI) is a leading cause of age-related cognitive decline, driven by cerebrovascular dysfunction and cerebral small vessel disease (CSVD). Emerging evidence suggests that cerebromicrovascular endothelial senescence plays an important role in the pathogenesis of VCI by promoting cerebral blood flow dysregulation, neurovascular uncoupling, blood-brain barrier (BBB) disruption, and the development of cerebral microhemorrhages (CMHs). This review explores the concept of cerebromicrovascular senescence as a continuum of vascular aging, linking macrovascular atherosclerosis with microvascular dysfunction. It examines the mechanisms by which endothelial senescence drives neurovascular pathology and highlights the impact of cardiovascular risk factors in accelerating these processes. We examine preclinical and clinical studies that provide compelling evidence that atherosclerosis-induced microvascular senescence exacerbates cognitive impairment. In particular, findings suggest that targeting senescent endothelial cells through senolytic therapy can restore cerebrovascular function and improve cognitive outcomes in experimental models of atherosclerosis. Given the growing recognition of microvascular senescence as a therapeutic target, further research is warranted to explore novel interventions such as senolytics, anti-inflammatory agents, and metabolic modulators. The development of circulating biomarkers of vascular senescence (e.g., senescence-associated secretory phenotype [SASP] components and endothelial-derived extracellular vesicles) could enable early detection and risk stratification in individuals at high risk for VCI. Additionally, lifestyle modifications, including the Mediterranean diet, hold promise for delaying endothelial senescence and mitigating cognitive decline. In conclusion, cerebromicrovascular senescence is a key mechanistic link between atherosclerosis and cognitive impairment. Addressing microvascular aging as a modifiable risk factor through targeted interventions offers a promising strategy for reducing the burden of VCI and preserving cognitive function in aging populations.

Chronic alcohol consumption accelerates cardiovascular aging and decreases cardiovascular reserve capacity

The pathology of cardiovascular aging is complex, involving mitochondrial dysfunction, oxidative and nitrative stress, oxidative DNA injury, impaired lipid metabolism, cell death, senescence, and chronic inflammation. These processes lead to remodeling and structural changes in the cardiovascular system, resulting in a progressive decline in cardiovascular reserve capacity and health, and an increased risk of diseases and mortality. Excessive alcohol consumption exacerbates these risks by promoting hypertension, stroke, arrhythmias, coronary artery disease, cardiomyopathy, and sudden cardiac death, yet the effects of chronic alcohol consumption on cardiovascular aging remain unclear. Herein, we explored the impact of a 6-month 5% Lieber-DeCarli alcohol diet in young (3 months old) and aging (24-26 months old) Fisher F344BNF1 rats. We assessed detailed hemodynamics, mitochondrial function, oxidative/nitrative stress, lipid metabolism, inflammation, cell death, senescence, and myocardial fibrosis using the pressure-volume system, isolated vascular rings, and various histological, biochemical, and molecular biology methods. Alcohol consumption in both young and aging rats impaired mitochondrial function, disrupted cholesterol and triglyceride metabolism, and increased oxidative/nitrative stress, inflammation, cell death, and senescence, leading to a decline in systolic contractile function. In aging rats, alcohol further exacerbated diastolic dysfunction and myocardial fibrosis. Alcohol also increased oxidative/nitrative stress, apoptosis, and senescence in the vasculature, contributing to endothelial dysfunction and increased total peripheral resistance. Additionally, alcohol exacerbated the aging-related ventriculo-arterial uncoupling and diminished cardiac efficiency, further reducing cardiovascular reserve capacity. In conclusion, chronic alcohol consumption promotes cardiovascular aging and further diminishes the already impaired cardiac and vascular reserve capacity associated with aging.

GLSP mitigates vascular aging by promoting Sirt7-mediated Keap1 deacetylation and Keap1-Nrf2 dissociation

Background and Purpose: Vascular aging is a prior marker of human aging and a significant contributor to atherosclerosis and vascular calcification. However, there are limited pharmacological options available to mitigate vascular aging. Thus, understanding the mechanisms underlying vascular aging and age-related atherosclerosis and vascular calcification is crucial. This study investigates the targets of vascular aging and elucidates the role and mechanisms of Ganoderma lucidum spore powder (GLSP) in mitigating vascular aging and aging-associated atherosclerosis as well as vascular calcification. Methods: The anti-vascular aging effects of GLSP was determined in aged C57BL/6J mice and the targets of GLSP was identified through transcriptome sequencing. Additionally, the protective effects of GLSP on the aged vasculature were assessed by examining atherosclerosis in apoE-/- mice and vascular calcification in VD3 and nicotine-induced mice. In vitro, the protective effects of GLSP triterpenes against vascular aging and calcification was determined in vascular smooth muscle cells (VSMCs). Results: GLSP exerted anti-vascular aging effects by regulating the cell cycle and senescence-associated secretory phenotype (SASP), mitigating DNA damage, reducing oxidative stress, improving mitochondrial function and modulating metabolic levels. Furthermore, GLSP improved vascular aging-associated atherosclerosis and vascular calcification in vivo. Mechanistically, RNA sequencing revealed an upregulation of Sirt7 expression after GLSP treatment. Sirt7 inhibitor exacerbated VSMCs senescence and calcification in senescent VSMCs and abolished the anti-senescence and the inhibitory effect of GLSP triterpenes on VSMCs senescence and calcification. Innovatively, we found that Sirt7 interacted with Keap1 and facilitated Keap1 deacetylation, which promoted Keap1-Nrf2 dissociation and consequently enhanced Nrf2 nuclear translocation and activation. Conclusion: GLSP alleviates vascular aging by exerting antioxidant effects through the activation of the Sirt7-Nrf2 axis, providing a promising new strategy for delaying vascular aging, atherosclerosis and vascular calcification.

Functions and application of circRNAs in vascular aging and aging-related vascular diseases

Circular RNAs (circRNAs), constituting a novel class of endogenous non-coding RNAs generated through the reverse splicing of mRNA precursors, possess the capacity to regulate gene transcription and translation. Recently, the pivotal role of circRNAs in controlling vascular aging, as well as the pathogenesis and progression of aging-related vascular diseases, has garnered substantial attention. Vascular aging plays a crucial role in the increased morbidity and mortality of the elderly. Endothelial cells (ECs) and vascular smooth muscle cells (VSMCs) are crucial components of the intima and media layers of the vascular wall, respectively, and are closely involved in the mechanisms underlying vascular aging and aging-related vascular diseases. The review aims to provide a comprehensive exploration of the connection between circRNAs and vascular aging, as well as aging-related vascular diseases. Besides, circRNAs, as potential diagnostic markers or therapeutic targets for vascular aging and aging-related vascular diseases, will be discussed thoroughly, along with the challenges and limitations of their clinical application. Investigating the role and molecular mechanisms of circRNAs in vascular aging and aging-related vascular diseases will provide a novel insight into early diagnosis and therapy, and even effective prognosis assessment of these conditions.

Estimated glucose processing rates and the association of chronic kidney disease and proteinuria in non-diabetic adults

The study, which was based on NHANES data (1999-2018), included 21,234 nondiabetic individuals aged 20 years and older to investigate the associations between the estimated glucose disposal rate (eGDR) and the risk of chronic kidney disease (CKD) and proteinuria. CKD was defined as an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2, and proteinuria was defined as a urinary albumin-to-creatinine ratio (UACR) exceeding 30 mg/g. The results demonstrated a significant inverse association between eGDR levels and the risks of CKD and proteinuria. After adjusting for potential confounders, the association between eGDR and CKD showed that, compared with those for Q1, the adjusted odds ratios (ORs) for Q2, Q3, and Q4 were 0.82 (95% CI: 0.61-1.11), 0.62 (95% CI: 0.39-0.98), and 0.55 (95% CI: 0.28-1.05), respectively. For the relationship between eGDR and proteinuria, the adjusted ORs for Q2, Q3, and Q4 were 0.54 (95% CI: 0.42-0.69), 0.41 (95% CI: 0.27-0.62), and 0.65 (95% CI: 0.43-0.98), respectively. Moreover, each standard deviation increase in eGDR was associated with a 9% reduction in CKD risk (OR: 0.91, 95% CI: 0.85-0.98) and a 13% reduction in proteinuria risk (OR: 0.87, 95% CI: 0.82-0.93). Further adjustments via restricted cubic spline (RCS) regression analysis revealed a significant nonlinear relationship between eGDR and CKD and a U-shaped relationship between eGDR and proteinuria. A lower risk of proteinuria was observed when eGDR levels were between 8.70 and 9.91. These findings, combined with those of previous studies, suggest that eGDR may serve as a potential alternative metric for insulin resistance (IR). In nondiabetic individuals, the eGDR was significantly associated with the risk of CKD and proteinuria, with a notable nonlinear pattern in these relationships.

Cerebrovascular longitudinal atlas: Changes in cerebral arteries in unruptured intracranial aneurysm patients followed with MRA

BACKGROUND

Patterns of change in cerebrovascular (CV) morphology associated with aging are highly relevant to the incidence and progression of CV disease, particularly stroke. Intracranial aneurysms (IA), a leading cause of hemorrhagic stroke, are linked with factors such as blood flow, arterial stiffness, and inflammation that may also drive other changes in CV morphology. We worked with a cohort of longitudinally-imaged IA patients to construct the first longitudinal atlas of CV morphology and studied its relationship with disease.

METHODS

110 IA patients, ranging from 19 to 84 years old at IA detection, were monitored using 3D magnetic resonance angiography (MRA) for a mean of 6.11 (2.60) years with 3.6 (1.3) scans per patient. Using 405 image studies, we applied a machine learning diffeomorphic shape analysis to construct a longitudinal atlas of the cerebral arteries which defined a general trajectory of CV morphological change vs. age. This was paired with a centerline analysis to verify changes in individual arteries.

RESULTS

Patient characteristics influenced the speed of CV shape change (e.g. diabetes mellitus, faster, p = 0.016), while other factors mapped to older CV age (e.g. hypertension, p = 0.0004). In parallel, we found that groups including autosomal dominant polycystic kidney disease (p = 0.0004), sex (p = 0.005), smoking (p = 0.046), and IA growth (p = 0.020) shared CV morphology characteristics. The centerline analysis validated changes consistent with the longitudinal atlas.

CONCLUSION

A general CV trajectory of increasing artery length and tortuosity over a period of several decades was found. Although specific IA characteristics were not found to significantly affect this trajectory, these changes in the CV may contribute to increases in IA risk with aging. While our longitudinal findings were consistent with previous cross-sectional studies of individuals without IA, it remains to be determined whether the pattern of morphological change we observed is representative of aging within the general population. The model we developed provides a basis for integrating CV morphological change into understanding of aging and disease.

The brain-heart axis: integrative cooperation of neural, mechanical and biochemical pathways

The neural and cardiovascular systems are pivotal in regulating human physiological, cognitive and emotional states, constantly interacting through anatomical and functional connections referred to as the brain-heart axis. When this axis is dysfunctional, neurological conditions can lead to cardiovascular disorders and, conversely, cardiovascular dysfunction can substantially affect brain health. However, the mechanisms and fundamental physiological components of the brain-heart axis remain largely unknown. In this Review, we elucidate these components and identify three primary pathways: neural, mechanical and biochemical. The neural pathway involves the interaction between the autonomic nervous system and the central autonomic network in the brain. The mechanical pathway involves mechanoreceptors, particularly those expressing mechanosensitive Piezo protein channels, which relay crucial information about blood pressure through peripheral and cerebrovascular connections. The biochemical pathway comprises many endogenous compounds that are important mediators of neural and cardiovascular function. This multisystem perspective calls for the development of integrative approaches, leading to new clinical specialties in neurocardiology.

Bioelectrically Reprogramming Hydrogels Rejuvenate Vascularized Bone Regeneration in Senescence

Senescent bone tissue displays a pathological imbalance characterized by decreased angiogenesis, disrupted bioelectric signaling, ion dysregulation, and reduced stem cell differentiation. Once bone defects occur, this pathological imbalance makes them difficult to repair. An innovative synergistic therapeutic strategy is utilized to reverse these pathological imbalances via a conductive hydrogel doped with magnesium ion (Mg2+)-modified black phosphorus (BP). The hydrogel reprograms electrical signals, restores Mg2+ homeostasis, reconstructs physiological signals, and promotes blood vessel regeneration in senile bone defects. The conductive hydrogel synergistically restores both the chemical and bioelectric signals within the bone microenvironment. This hydrogel increases the expression of vascular endothelial growth factor (VEGF) and VEGF receptor-2 (VEGFR2), activates the PI3K-AKT-eNOS pathway, and significantly increases the angiogenic ability of vascular endothelial cells in the aged state. In addition, the conductive hydrogel normalizes calcium ion (Ca2+) influx, increases the accumulation of osteogenic transcription factors in the nucleus, and promotes the osteogenic differentiation of senescent stem cells. This innovative treatment strategy restores bone-vascular coupling in areas of senile bone defects, achieves effective vascularized bone regeneration, and has good potential for the treatment of senile bone defects.

Elucidating emerging signaling pathways driving endothelial dysfunction in cardiovascular aging

The risk for developing cardiovascular diseases dramatically increases in older individuals, and aging vasculature plays a crucial role in determining their morbidity and mortality. Aging disrupts endothelial balance between vasodilators and vasoconstrictors, impairing function and promoting pathological vascular remodeling. In this Review, we discuss the impact of key and emerging molecular pathways that transduce aberrant inflammatory signals (i.e., chronic low-grade inflammation-inflammaging), oxidative stress, and mitochondrial dysfunction in aging vascular compartment. We focus on the interplay between these events, which contribute to generating a vicious cycle driving the progressive alterations in vascular structure and function during cardiovascular aging. We also discuss the primary role of senescent endothelial cells and vascular smooth muscle cells, and the potential link between vascular and myeloid cells, in impairing plaque stability and promoting the progression of atherosclerosis. The aim of this summary is to provide potential novel insights into targeting these processes for therapeutic benefit.

Rest-to-work and work-to-rest transients of interstitial PO2 in spinotrapezius muscle of young and old male rats

Muscle function declines with age. Since the primary energy source for contraction is aerobic, this study investigated age-related changes in muscle oxygenation dynamics to: characterize PO2 transients during rest-work transitions, identify age-specific differences in oxygen delivery/utilization balance, and examine the relationship between interstitial and arterial oxygen tension (PO2). Interstitial PO2 was measured with a high-resolution stroboscopic phosphorescence quenching technique to map intra-contractile dynamics during changes in muscle activity-rest-to-work (RtW) and work-to-rest (WtR) in rats aged three (young) and 23 (old) months. RtW (τw) and WtR (τr) PO2 transitions had lag periods and mono-exponential time constants. In young muscles, lag was 4 s, τw = 9.0 ± 3.7 s, and τr = 15.4 ± 3.9 s. For old, lag was also 4 s with increases to τw = 15.9 ± 3.5 s and τr = 41.4 ± 8.3 s. Resting PO2's were higher for young than for old (66.7 ± 13.7 vs. 60.2 ± 13.0 mmHg; p < 0.05). Work reduced PO2 with a greater effect on old (42.5 ± 14.0 vs. 28.3 ± 16.5 mmHg; p < 0.05). Intra-contractile measurements revealed a spike in PO2 (11 mmHg amplitude for >200 ms), which was absent in old. Further, sustained exercise in young showed a rising trend in PO2, while old remained at nadir. The missing PO2 spike in aged muscle contributes to reduced PO2 during work and may explain age-related loss of endurance.

Titin is a new factor regulating arterial stiffness through vascular smooth muscle cell tone in male rats

Arterial stiffness is a robust predictor of cardiovascular disease and mortality. As such, there is substantial interest in uncovering its causal factors for the development of targeted treatments to regulate arterial stiffness. The elastic protein titin is a key determinant of myocardial stiffness, yet whether it plays a role in regulating arterial stiffness is unknown. In this study, we aimed to investigate the role of titin in vascular smooth muscle cell (VSMC) and overall arterial stiffness. To do this, we took advantage of rats lacking RNA binding motif 20 (RBM20), the primary splicing regulator of titin, in striated muscles. Using this model, we demonstrate that RBM20 regulates titin isoform expression in smooth muscle, with loss of the protein leading to the expression of larger titin isoforms. We show that the expression of larger titin reduces the stiffness of VSMCs. While decreased titin-based VSMC stiffness did not affect baseline arterial stiffness, we found that arterial stiffness was reduced in response to a challenge with the potent vasoconstrictor angiotensin II (Ang II). The observed reduction in arterial stiffness following Ang II treatment was not the result of changes in either the extracellular matrix or myofilaments. We further show that the expression of a larger titin isoform ameliorates cardiac remodeling caused by Ang II-associated hypertension. In summary, our study provides the first evidence that titin regulates VSMC stiffness, which is relevant for arterial stiffness in the context of elevated blood pressure. Furthermore, our data provide proof-of-concept evidence that targeting RBM20 to reduce arterial stiffness through titin isoform switching may benefit aging- or hypertension-associated arterial stiffness and vascular diseases.

Restoration of angiogenic capacity in senescent endothelial cells by a pharmacological reprogramming approach

Senescent endothelial cells (EC) are key players in the pathophysiology of cardiovascular diseases and are characterized by a reduced angiogenic and regenerative potential. Therefore, targeting these cells has been suggested as an effective therapeutic strategy to reduce vascular disease burden and potentially improve health and lifespan of humans. Here, we aimed to establish a pharmacological, partial reprogramming strategy to improve replicative senescent endothelial cell function in the context of angiogenesis. We demonstrate that our treatment improves tube formation and sprouting capacity but also increases proliferation and migration capacity in vitro. Further, inflammation and DNA damage were reduced in the replicative senescent cells. These processes were initiated by a short and timely-restricted overexpression of the Yamanaka-factors induced by our pharmacological strategy. The advantage of these compounds is that they are FDA approved in their respective concentrations which could pave the way for use in a clinical setting.

UFMylation maintains YAP stability to promote vascular endothelial cell senescence

Endothelial cell (EC) senescence is an accomplice for vascular aging, which leads to cardiovascular diseases (CVDs). Evidences showed that Hippo-Yes-associated protein (YAP) signaling pathway plays an essential role in aging-associated CVDs. Here, we reported that YAP was elevated in senescent human umbilical vein endothelial cells (HUVECs) and inhibition of YAP could attenuate HUVECs senescence. Besides, our findings revealed that the activity of UFMylation and the level of YAP were both elevated in senescent cells. Furthermore, UFM1-modified YAP was upregulated in senescent ECs, and increased the stability of YAP. Importantly, we found that compound 8.5, an inhibitor of E1 of UFMylation, can alleviate vascular aging in aged mice. Together, our finding provides molecular mechanism by which UFMylation maintains YAP stability and exerts an important role in promoting cell senescence, and identified that a previously unrecognized UFMylation is a potential therapeutic target for anti-aging.

Persisting blood-brain barrier disruption following cisplatin treatment in a mouse model of chemotherapy-associated cognitive impairment

Chemotherapy-related cognitive impairment, commonly referred to as "chemobrain," significantly affects cancer survivors' quality of life, yet its underlying mechanisms remain unclear. Most chemotherapeutic agents cannot cross the blood-brain barrier (BBB), yet they cause central nervous system side effects, suggesting alternative pathways of toxicity. Given that these drugs interact with the cerebrovascular endothelium at their highest concentrations, it is logical to hypothesize that endothelial damage contributes to these effects. Our recent studies demonstrated that paclitaxel-induced cognitive impairment in a mouse model results in a partial BBB disruption and subsequent neuroinflammation, mediated by chemotherapy-induced endothelial senescence. In this pilot study, we used two-photon microscopy to assess BBB permeability in mice receiving a clinically relevant cisplatin regimen, evaluating the leakage of fluorescent dextran tracers of varying molecular weights. Two months post-treatment, cisplatin-treated mice exhibited significantly increased BBB permeability to smaller molecular tracers (40 kDa, 3 kDa, and 0.3 kDa) compared to controls, indicating sustained BBB disruption. These results align with our findings for paclitaxel and suggest that chemotherapy-induced endothelial damage and senescence play a central role in cognitive impairments. Interventions targeting endothelial health could mitigate these long-term effects, improving cognitive outcomes for cancer survivors.

Cxcl9 modulates aging associated microvascular metabolic and angiogenic dysfunctions in subcutaneous adipose tissue

Microvascular aging, predominantly driven by endothelial cells (ECs) dysfunction, is a critical early event in cardiovascular diseases. However, the specific effects of aging on ECs across the microvascular network segments and the associated mechanisms are not fully understood. In this study, we detected a microvascular rarefaction and a decreased proportion of venular ECs in the subcutaneous adipose tissue of aged mice using light-sheet immunofluorescence microscopy and single-cell RNA sequencing. Moreover, aged ECs, especially in the venular subtype, exhibited a pseudotemporal transition to a terminal state characterized by diminished oxidative phosphorylation and strengthened cytokine signaling. Metabolic flux balance analysis predicted that among the 13 differentially expressed cytokines identified in aged EC subpopulations, Cxcl9 was strongly correlated with impaired oxidative phosphorylation in aged ECs. It was further validated using microvascular ECs treated with Cxcl9. Notably, the G protein-coupled receptor signaling pathway was subsequently suppressed, in which Aplnr suppression was also observed in aged ECs, contributing to their impaired energy metabolism and reduced angiogenesis. Based on these findings, we propose Cxcl9 as a biomarker for aging-related dysfunction of microvascular ECs, suggesting that targeting Cxcl9 signaling may help combat microvascular aging.

Effects of Age and Sex on Systemic Inflammation and Cardiometabolic Function in Individuals With Type 2 Diabetes

BACKGROUND

Systemic inflammation, aging, and type 2 diabetes (T2D) lead to varying degrees of cardiovascular dysfunction and impaired aerobic exercise capacity. This study evaluates the impact of inflammation and sex differences on coronary and peripheral vascular function and exercise capacity in older individuals with and without T2D.

METHODS

Older individuals (aged≥65 years) underwent biochemical and tissue inflammatory phenotyping, cardiopulmonary exercise testing, cardiovascular magnetic resonance imaging, and vascular reactivity testing. Correlation and regression analyses determined the effects of systemic inflammation, older age, and sex on cardiovascular health, stratified by T2D status.

RESULTS

For the 133 recruited individuals (44% women; median age, 71±7 years, 41% with T2D), the presence of T2D most significantly increased the white blood cell count (P=0.004; P.adj.=0.140) among markers of systemic inflammation. White blood cell count was comparable in men and women. Hyperemic myocardial blood flow and flow-mediated and flow-independent nitroglycerin-induced brachial artery dilation were significantly impaired in men but not women with T2D. Peak oxygen consumption during exercise was lower with T2D (P=0.021), and overall reduced in women compared with men (P=0.002). Across all participants, both peak oxygen consumption during exercise and hyperemic myocardial blood flow were significantly impaired with increased white blood cell count. Women showed more adverse myocardial remodeling assessed by extracellular volume than men (P=0.008), independently of T2D status.

CONCLUSIONS

The pathophysiological manifestations of T2D on vascular function and aerobic exercise capacity are distinct in older men and women, and this may reflect underlying differences in vascular and myocardial aging in the presence of T2D.

Cardiometabolic Trajectories Preceding Dementia in Community-Dwelling Older Individuals

Importance

Poor cardiometabolic health is a risk factor associated with cognitive impairment in later life, but it remains unclear whether cardiometabolic trajectories can serve as early markers associated with dementia.

Objective

To compare cardiometabolic trajectories that precede dementia diagnosis with those among individuals without dementia.

Design, Setting, and Participants

This case-control study analyzed a sample drawn from community-dwelling participants in the Aspirin in Reducing Events in the Elderly (ASPREE) study. Recruitment through primary care physicians occurred between March 2010 and December 2014, with participants followed up for a maximum of 11 years. Dementia cases were matched on sociodemographic characteristics and time of diagnosis to dementia-free controls. Data analysis was performed between February and June 2024.

Exposures

Body mass index (BMI), waist circumference, systolic and diastolic blood pressure, glucose levels, high- and low-density lipoprotein (HDL and LDL) and total cholesterol levels, and triglyceride levels were measured repeatedly between 2010 and 2022.

Main Outcomes and Measures

Dementia (Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition] criteria) was adjudicated by an international expert panel.

Results

Among 5390 participants (mean [SD] age, 76.9 [4.8] years; 2915 women [54.1%]), there were 2655 individuals (49.3%) with less than 12 years of education. The study included 1078 dementia cases and 4312 controls. Up to a decade before diagnosis, dementia cases compared with controls had lower BMI for all years from -7 years (marginal estimate, 27.52 [95% CI, 27.24 to 27.79] vs 28.00 [95% CI, 27.86 to 28.14]; contrast P = 002) to 0 years (marginal estimate, 26.09 [95% CI, 25.81 to 26.36] vs 27.22 [95% CI, 27.09 to 27.36]; contrast P < .001) and lower waist circumference for all years from -10 years (marginal estimate, 95.45 cm [95% CI, 94.33 to 96.57 cm] vs 97.35 cm [95% CI, 96.79 to 97.92 cm]; contrast P = .003) to 0 years (marginal estimate, 93.90 [95% CI, 93.15 cm to 94.64 cm] vs 96.67 cm [95% CI, 96.30 to 97.05 cm]; contrast P < .001); cases also had a faster decline in BMI (linear change β, -0.13 [95% CI, -0.19 to -0.08]) and waist circumference (linear change β, -0.30 cm [95% CI, -0.51 to -0.08 cm]). Compared with controls, cases generally had higher HDL levels, in particular from 5 years (marginal estimate, 62.57 mg/dL [95% CI, 61.59 to 63.56 mg/dL] vs 60.84 mg/dL [95% CI, 60.35 to 61.34 mg/dL]; contrast P = .002) to 3 years (marginal estimate, 62.78 mg/dL [95% CI, 61.82 to 63.74 mg/dL] vs 61.08 mg/dL [95% CI, 60.60 to 61.56 mg/dL]; contrast P = .002) before dementia but with a decline in levels just before diagnosis (linear change β, -0.47 mg/dL [95% CI, -0.86 to -0.07 mg/dL]). Dementia cases had lower systolic blood pressure and triglyceride levels in the decade before diagnosis and higher LDL and total cholesterol levels, but these were not significantly different from controls.

Conclusions and Relevance

In this study of older individuals, decline in BMI, waist circumference, and HDL occurred up to a decade before dementia diagnosis. These findings provide insights into cardiometabolic changes preceding dementia and the potential for early monitoring and intervention.

The untapped potential of cold water therapy as part of a lifestyle intervention for promoting healthy aging

Healthy aging is a crucial goal in aging societies of the western world, with various lifestyle strategies being employed to achieve it. Among these strategies, hydrotherapy stands out for its potential to promote cardiovascular and mental health. Cold water therapy, a hydrotherapy technique, has emerged as a lifestyle strategy with the potential capacity to evoke a wide array of health benefits. This review aims to synthesize the extensive body of research surrounding cold water therapy and its beneficial effects on various health systems as well as the underlying biological mechanisms driving these benefits. We conducted a search for interventional and observational cohort studies from MEDLINE and EMBASE up to July 2024. Deliberate exposure of the body to cold water results in distinct physiological responses that may be linked to several health benefits. Evidence, primarily from small interventional studies, suggests that cold water therapy positively impacts cardiometabolic risk factors, stimulates brown adipose tissue and promotes energy expenditure-potentially reducing the risk of cardiometabolic diseases. It also triggers the release of stress hormones, catecholamines and endorphins, enhancing alertness and elevating mood, which may alleviate mental health conditions. Cold water therapy also reduces inflammation, boosts the immune system, promotes sleep and enhances recovery following exercise. The optimal duration and temperature needed to derive maximal benefits is uncertain but current evidence suggests that short-term exposure and lower temperatures may be more beneficial. Overall, cold water therapy presents a potential lifestyle strategy to enhancing physical and mental well-being, promoting healthy aging and extending the healthspan, but definitive interventional evidence is warranted.

Genomic instability and genetic heterogeneity in aging: insights from clonal hematopoiesis (CHIP), monoclonal gammopathy (MGUS), and monoclonal B-cell lymphocytosis (MBL)

Aging is a multifaceted process characterized by a gradual decline in physiological function and increased susceptibility to a range of chronic diseases. Among the molecular and cellular mechanisms driving aging, genomic instability is a fundamental hallmark, contributing to increased mutation load and genetic heterogeneity within cellular populations. This review explores the role of genomic instability and genetic heterogeneity in aging in the hematopoietic system, with a particular focus on clonal hematopoiesis of indeterminate potential (CHIP), monoclonal gammopathy of undetermined significance (MGUS), and monoclonal B-cell lymphocytosis (MBL) as biomarkers. CHIP involves the clonal expansion of hematopoietic stem cells with somatic mutations. In contrast, MGUS is characterized by the presence of clonal plasma cells producing monoclonal immunoglobulins, while MBL is characterized by clonal proliferation of B cells. These conditions are prevalent in the aging population and serve as measurable indicators of underlying genomic instability. Studying these entities offers valuable insights into the mechanisms by which somatic mutations accumulate and drive clonal evolution in the hematopoietic system, providing a deeper understanding of how aging impacts cellular and tissue homeostasis. In summary, the hematopoietic system serves as a powerful model for investigating the interplay between genomic instability and aging. Incorporating age-related hematological conditions into aging research, alongside other biomarkers such as epigenetic clocks, can enhance the precision and predictive power of biological age assessments. These biomarkers provide a comprehensive view of the aging process, facilitating the early detection of age-related diseases and hopefully enabling personalized healthcare strategies.

CCL11 (Eotaxin) Promotes the Advancement of Aging-Related Cardiovascular Diseases

Aging-related diseases, such as cardiovascular diseases (CVDs), neurodegeneration, cancer, etc., have become important factors that threaten the lifespans of older individuals. A chronic inflammatory response is closely related to aging-related diseases. Establishing inflammatory aging clock (iAGE, deep-learning methods on blood immune biomarkers to construct a metric for age-related chronic inflammation) successfully predicted the positive correlation between several factors, including serum C-C-motif chemokine ligand 11 (CCL11) and aging-related diseases. Recently, the role and mechanism of CCL11, an eosinophilic chemokine, in neurodegenerative diseases have been widely reported. Additionally, many research studies have shown a positive correlation with CVDs, but the underlying mechanism remains unknown. This review focuses on the relationship between chronic inflammation and aging. The role of CCL11 will be discussed and summarized in relation to aging-related diseases, especially CVDs.

Ginkgolide B increases healthspan and lifespan of female mice

Various anti-aging interventions show promise in extending lifespan, but many are ineffective or even harmful to healthspan. Ginkgolide B (GB), derived from Ginkgo biloba, reduces aging-related morbidities such as osteoporosis, yet its effects on healthspan and longevity have not been fully understood. In this study, we found that continuous oral administration of GB to female mice beginning at 20 months of age extended median survival and median lifespan by 30% and 8.5%, respectively. GB treatment also decreased tumor incidence; enhanced muscle quality, physical performance and metabolism; and reduced systemic inflammation and senescence. Single-nucleus RNA sequencing of skeletal muscle tissue showed that GB ameliorated aging-associated changes in cell type composition, signaling pathways and intercellular communication. GB reduced aging-induced Runx1+ type 2B myonuclei through the upregulation of miR-27b-3p, which suppresses Runx1 expression. Using functional analyses, we found that Runx1 promoted senescence and cell death in muscle cells. Collectively, these findings suggest the translational potential of GB to extend healthspan and lifespan and to promote healthy aging.

Vascular inflammaging: Endothelial CEACAM1 expression is upregulated by TNF-α via independent activation of NF-κB and β-catenin signaling

Chronic inflammation with progressive age, called inflammaging, contributes to the pathogenesis of cardiovascular diseases. Previously, we have shown increased vascular expression of the Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) in aged mice and humans, presumably via mutual upregulation with the pro-inflammatory cytokine TNF-α. CEACAM1 is critical for aging-associated vascular alterations like endothelial dysfunction, fibrosis, oxidative stress, and sustained inflammation and can be regarded as a main contributor to vascular inflammaging. This study was conducted to elucidate the mechanisms underlying endothelial CEACAM1 upregulation by TNF-α in detail. Using wildtype (WT) and TNF-α knockout (Tnf-/-) mice, we confirmed that the aging-related upregulation of endothelial CEACAM1 critically depends on TNF-α. The underlying mechanisms were analyzed in an endothelial cell culture model. TNF-α time-dependently upregulated CEACAM1 in vitro. In pharmacological experiments, we identified an early NF-κB- and a delayed β-catenin-mediated response. Involvement of β-catenin was further substantiated by siRNA-mediated knockdown of the β-catenin-targeted transcription factor TCF4. Both signaling pathways acted independent from each other. Elucidating the delayed response, co-immunoprecipitation analysis revealed release of β-catenin from adherens junctions by TNF-α. Finally, TNF-α activated Akt kinase by increasing its Ser473 phosphorylation. Consequently, Akt kinase facilitated β-catenin signaling by inhibiting its degradation via phosphorylation of GSK3β at Ser9 and by increased phosphorylation of β-catenin at Ser552 that augments its transcriptional activity. Taken together, our study provides novel mechanistic insights into the aging-related, inflammation-mediated endothelial upregulation of CEACAM1. Beyond the pathogenesis of cardiovascular diseases, these findings may be significant to all fields of inflammaging.

Sex-specific mechanisms in vascular aging: exploring cellular and molecular pathways in the pathogenesis of age-related cardiovascular and cerebrovascular diseases

Aging remains the foremost risk factor for cardiovascular and cerebrovascular diseases, surpassing traditional factors in epidemiological significance. This review elucidates the cellular and molecular mechanisms underlying vascular aging, with an emphasis on sex differences that influence disease progression and clinical outcomes in older adults. We discuss the convergence of aging processes at the macro- and microvascular levels and their contributions to the pathogenesis of vascular diseases. Critical analysis of both preclinical and clinical studies reveals significant sex-specific variations in these mechanisms, which could be pivotal in understanding the disparity in disease morbidity and mortality between sexes. The review highlights key molecular pathways, including oxidative stress, inflammation, and autophagy, and their differential roles in the vascular aging of males and females. We argue that recognizing these sex-specific differences is crucial for developing targeted therapeutic strategies aimed at preventing and managing age-related vascular pathologies. The implications for personalized medicine and potential areas for future research are also explored, emphasizing the need for a nuanced approach to the study and treatment of vascular aging.

Stay social, stay young: a bioanthropological outlook on the processes linking sociality and ageing

In modern human societies, social interactions and pro-social behaviours are associated with better individual and collective health, reduced mortality, and increased longevity. Conversely, social isolation is a predictor of shorter lifespan. The biological processes through which sociality affects the ageing process, as well as healthspan and lifespan, are still poorly understood. Unveiling the physiological, neurological, genomic, epigenomic, and evolutionary mechanisms underlying the association between sociality and longevity may open new perspectives to understand how lifespan is determined in a broader socio/evolutionary outlook. Here we summarize evidence showing how social dynamics can shape the evolution of life history traits through physiological and genetic processes directly or indirectly related to ageing and lifespan. We start by reviewing theories of ageing that incorporate social interactions into their model. Then, we address the link between sociality and lifespan from two separate points of view: (i) considering evidences from comparative evolutionary biology and bioanthropology that demonstrates how sociality contributes to natural variation in lifespan over the course of human evolution and among different human groups in both pre-industrial and post-industrial society, and (ii) discussing the main physiological, neurological, genetic, and epigenetic molecular processes at the interface between sociality and ageing. We highlight that the exposure to chronic social stressors deregulates neurophysiological and immunological pathways and promotes accelerated ageing and thereby reducing lifespan. In conclusion, we describe how sociality and social dynamics are intimately embedded in human biology, influencing healthy ageing and lifespan, and we highlight the need to foster interdisciplinary approaches including social sciences, biological anthropology, human ecology, physiology, and genetics.

Cerebromicrovascular mechanisms contributing to long COVID: implications for neurocognitive health

Long COVID (also known as post-acute sequelae of SARS-CoV-2 infection [PASC] or post-COVID syndrome) is characterized by persistent symptoms that extend beyond the acute phase of SARS-CoV-2 infection, affecting approximately 10% to over 30% of those infected. It presents a significant clinical challenge, notably due to pronounced neurocognitive symptoms such as brain fog. The mechanisms underlying these effects are multifactorial, with mounting evidence pointing to a central role of cerebromicrovascular dysfunction. This review investigates key pathophysiological mechanisms contributing to cerebrovascular dysfunction in long COVID and their impacts on brain health. We discuss how endothelial tropism of SARS-CoV-2 and direct vascular infection trigger endothelial dysfunction, impaired neurovascular coupling, and blood-brain barrier disruption, resulting in compromised cerebral perfusion. Furthermore, the infection appears to induce mitochondrial dysfunction, enhancing oxidative stress and inflammation within cerebral endothelial cells. Autoantibody formation following infection also potentially exacerbates neurovascular injury, contributing to chronic vascular inflammation and ongoing blood-brain barrier compromise. These factors collectively contribute to the emergence of white matter hyperintensities, promote amyloid pathology, and may accelerate neurodegenerative processes, including Alzheimer's disease. This review also emphasizes the critical role of advanced imaging techniques in assessing cerebromicrovascular health and the need for targeted interventions to address these cerebrovascular complications. A deeper understanding of the cerebrovascular mechanisms of long COVID is essential to advance targeted treatments and mitigate its long-term neurocognitive consequences.

Endothelial Colony-Forming Cells (ECFCs) in cerebrovascular aging: Focus on the pathogenesis of Vascular Cognitive Impairment and Dementia (VCID), and treatment prospects

Endothelial colony-forming cells (ECFCs), a unique endothelial progenitor subset, are essential for vascular integrity and repair, providing significant regenerative potential. Recent studies highlight their role in cerebrovascular aging, particularly in the pathogenesis of vascular cognitive impairment and dementia (VCID). Aging disrupts ECFC functionality through mechanisms such as oxidative stress, chronic inflammation, and cellular senescence, leading to compromised vascular repair and reduced neurovascular resilience. ECFCs influence key cerebrovascular processes, including neurovascular coupling (NVC), blood-brain barrier (BBB) integrity, and vascular regeneration, which are critical for cognitive health. Age-related decline in ECFC quantity and functionality contributes to vascular rarefaction, diminished cerebral blood flow (CBF), and BBB permeability-processes that collectively exacerbate cognitive decline. This review delves into the multifaceted role of ECFCs in cerebrovascular aging and underscores their potential as therapeutic targets in addressing age-related vascular dysfunctions, presenting new directions for mitigating the effects of aging on brain health.

Adherence to the Mediterranean diet and its protective effects against colorectal cancer: a meta-analysis of 26 studies with 2,217,404 participants

Colorectal cancer (CRC) is a major global health concern and represents a significant public health challenge in Hungary, where it exhibits some of the highest morbidity and mortality rates in the European Union. The Mediterranean diet has been suggested to reduce the incidence of CRC, but comprehensive evidence from diverse study designs is needed to substantiate this effect. A systematic literature search was conducted in PubMed, ClinicalTrials.gov, CENTRAL, and the Web of Science to identify randomized controlled trials and human clinical trials from 2008 to 2024 to identify relevant studies. Statistical analysis was performed using the https://metaanalysisonline.com web application using a random effects model to estimate the pooled hazard rates (HRs). Forest plots, funnel plots, and Z-score plots were utilized to visualize results. We identified 15 clinical trials and 9 case-control studies, encompassing a total of 2,217,404 subjects. The pooled analysis indicated that adherence to the Mediterranean diet significantly reduced the prevalence of CRC (HR = 0.84, 95% CI = 0.78-0.91, p < 0.01). This protective effect was consistent across sexes, with HRs of 0.85 (95% CI = 0.75-0.97, p = 0.01) for males and 0.88 (95% CI = 0.79-0.99, p = 0.03) for females. Case-control studies specifically showed a substantial effect (HR = 0.51, 95% CI = 0.38-0.68, p < 0.01). Notable heterogeneity was observed across studies, yet the a priori information size was substantially below the cumulative sample size, ensuring sufficient data for reliable conclusions. The findings from this meta-analysis reinforce the protective role of the Mediterranean diet against CRC. The results of this meta-analysis will inform dietary interventions designed to mitigate CRC risk, which are conducted within the framework of the Semmelweis Study, an ongoing comprehensive cohort study at Semmelweis University, designed to explore the multifaceted causes of unhealthy aging in Hungary. These interventions aim to explore the practical application of Mediterranean dietary patterns in reducing CRC incidence among the Hungarian population.

The role of atrial fibrillation in vascular cognitive impairment and dementia: epidemiology, pathophysiology, and preventive strategies

The aging population in Europe faces a substantial burden from dementia, with vascular cognitive impairment and dementia (VCID) being a preventable cause. Atrial fibrillation (AF), a common cardiac arrhythmia, increases the risk of VCID through mechanisms such as thromboembolism, cerebral hypoperfusion, and inflammation. This review explores the epidemiology, pathophysiology, and preventive strategies for AF-related VCID. Epidemiological data indicate that AF prevalence rises with age, affecting up to 12% of individuals over 80. Neuroimaging studies reveal chronic brain changes in AF patients, including strokes, lacunar strokes, white matter hyperintensities (WMHs), and cerebral microbleeds (CMHs), while cognitive assessments show impairments in memory, executive function, and attention. The COVID-19 pandemic has exacerbated the underdiagnosis of AF, leading to an increase in undiagnosed strokes and cognitive impairment. Many elderly individuals did not seek medical care due to fear of exposure, resulting in delayed diagnoses. Additionally, reduced family supervision during the pandemic contributed to missed opportunities for early detection of AF and related complications. Emerging evidence suggests that long COVID may also elevate the risk of AF, further complicating the management of this condition. This review underscores the importance of early detection and comprehensive management of AF to mitigate cognitive decline. Preventive measures, including public awareness campaigns, patient education, and the use of smart devices for early detection, are crucial. Anticoagulation therapy, rate and rhythm control, and addressing comorbid conditions are essential therapeutic strategies. Recognizing and addressing the cardiovascular and cognitive impacts of AF, especially in the context of the COVID-19 pandemic, is essential for advancing public health.

The Role of Immune Cells in Moyamoya Disease

Moyamoya disease (MMD) is a rare progressive cerebrovascular disorder characterized by the stenosis or occlusion of the terminal segments of the internal carotid arteries, leading to the development of abnormal collateral vascular networks. These networks are a compensatory mechanism for reduced blood flow to the brain. Despite extensive research, the exact etiology of MMD remains unknown, although recent studies suggest that immune system dysfunction plays a critical role in its pathogenesis. In particular, the involvement of immune cells such as T cells, macrophages, and dendritic cells has been increasingly recognized. These immune cells contribute to the inflammatory process and vascular remodeling observed in MMD patients, further complicating the disease's progression. Inflammation and immune-mediated damage to the vessel walls may accelerate the narrowing and occlusion of arteries, exacerbating ischemic events in the brain. Additionally, studies have revealed that certain genetic and environmental factors can influence immune system activation in MMD, linking these pathways to disease development. This review aims to provide a comprehensive overview of the immune mechanisms at play in MMD, focusing on how immune cells participate in vascular injury and remodeling. Understanding these immunological processes may offer new therapeutic targets to halt or reverse disease progression, potentially leading to more effective treatment strategies for MMD.

Biological aging traits mediate the association between cardiovascular health levels and all-cause and cardiovascular mortality among adults in the U.S. without cardiovascular disease

The American Heart Association's (AHA) Life's Essential 8 (LE8) metrics provide a framework for assessing cardiovascular health (CVH). This study evaluates the relationship between CVH levels from LE8 and mortality risk, considering biological aging's role. Using data from the NHANES non-CVD adult population, CVH scores were categorized as low (< 50), moderate (50-79), and high (≥ 80) per AHA guidelines. Cox regression model assessed the impact of CVH levels on all-cause and cardiovascular mortality, while examining four aging indicators as mediators. RCS explored the relationships between CVH scores and mortality risk. The model's performance was evaluated using nine machine learning algorithms, with SHAP analysis on the best model to determine CVH score components' importance. Cox regression showed that all-cause mortality rates decreased by 35% for moderate and 54% for high CVH groups compared to low CVH. The high CVH group had a 59% lower cardiovascular mortality rate. Each unit increase in CVH score reduced all-cause and cardiovascular mortality to 0.98 times. RCS analysis revealed a nonlinear trend between CVH scores and mortality risk. Biological aging indicators significantly mediated the CVH-mortality relationship, with PhenoAge (21.57%) and KDM-Age (20.33%) showing the largest effects. The XGBoost model outperformed others, with SHAP analysis ranking CVH components: physical activity, nicotine, blood pressure, BMI, lipids, healthy eating index, blood glucose, and sleep. Higher CVH levels correlate with reduced all-cause and cardiovascular mortality risk, with biological aging mediating these effects. Adhering to AHA's LE8 metrics is recommended to enhance life expectancy in the non-CVD population.

Biomimetic tubular materials: from native tissues to a unifying view of new vascular, tracheal, gastrointestinal, oesophageal, and urinary grafts

Repairing tubular tissues-the trachea, the esophagus, urinary and gastrointestinal tracts, and the circulatory system-from trauma or severe pathologies that require resection, calls for new, more effective graft materials. Currently, the relatively narrow family of materials available for these applications relies on synthetic polymers that fail to reproduce the biological and physical cues found in native tissues. Mimicking the structure and the composition of native tubular tissues to elaborate functional grafts is expected to outperform the materials currently in use, but remains one of the most challenging goals in the field of biomaterials. Despite their apparent diversity, tubular tissues share extensive compositional and structural features. Here, we assess the current state of the art through a dual layer model, reducing each tissue to an inner epithelial layer and an outer muscular layer. Based on this model, we examine the current strategies developed to mimic each layer and we underline how each fabrication method stands in providing a biomimetic material for future clinical translation. The analysis provided here, addressed to materials chemists, biomaterials engineers and clinical staff alike, sets new guidelines to foster the elaboration of new biomimetic materials for effective tubular tissue repair.

Unveiling the molecular and cellular links between obstructive sleep apnea-hypopnea syndrome and vascular aging

ABSTRACT

Vascular aging (VA) is a common etiology of various chronic diseases and represents a major public health concern. Intermittent hypoxia (IH) associated with obstructive sleep apnea-hypopnea syndrome (OSAHS) is a primary pathological and physiological driver of OSAHS-induced systemic complications. A substantial proportion of OSAHS patients, estimated to be between 40% and 80%, have comorbidities such as hypertension, heart failure, coronary artery disease, pulmonary hypertension, atrial fibrillation, aneurysm, and stroke, all of which are closely associated with VA. This review examines the molecular and cellular features common to both OSAHS and VA, highlighting decreased melatonin secretion, impaired autophagy, increased apoptosis, increased inflammation and pyroptosis, increased oxidative stress, accelerated telomere shortening, accelerated stem cell depletion, metabolic disorders, imbalanced protein homeostasis, epigenetic alterations, and dysregulated neurohormonal signaling. The accumulation and combination of these features may underlie the pathophysiological link between OSAHS and VA, but the exact mechanisms by which OSAHS affects VA may require further investigation. Taken together, these findings suggest that OSAHS may serve as a novel risk factor for VA and related vascular disorders, and that targeting these features may offer therapeutic potential to mitigate the vascular risks associated with OSAHS.

Dietary flaxseed: Cardiometabolic benefits and its role in promoting healthy aging

Flaxseed, a rich source of omega-3 polyunsaturated fatty acid alpha-linolenic acid (ALA), lignans, and soluble fiber, has attracted attention for its potential to improve multiple cardiometabolic risk factors. While its benefits are well-recognized, comprehensive evaluations of its direct impact on clinical outcomes, such as the prevention or progression of cardiometabolic diseases, remain limited. Additionally, its potential to support healthy aging and longevity through fundamental biological mechanisms has not been fully elucidated. This review synthesizes existing research on flaxseed supplementation, highlighting its effects on cardiometabolic risk factors and outcomes, the underlying biological mechanisms, and its broader implications for health promotion and aging. Findings demonstrate that flaxseed supplementation significantly improves several cardiometabolic risk factors, including body weight, body mass index, lipid levels, blood pressure, glycemic measures, markers of inflammation (e.g., C-reactive protein and interleukin-6), oxidative stress, and liver enzymes. Blood pressure reductions range from approximately 2 to 15 mmHg for systolic blood pressure and 1 to 7 mmHg for diastolic blood pressure, with the magnitude influenced by dose, duration, and baseline risk profiles. While direct evidence linking flaxseed to the prevention of hypertension, metabolic syndrome, metabolic dysfunction-associated steatotic liver disease, type 2 diabetes, chronic kidney disease, and cardiovascular disease is limited, its bioactive components-ALA, lignans, and fiber-are strongly associated with reduced risks of these conditions. The benefits of flaxseed are mediated through multiple pathways, including anti-inflammatory and antioxidant effects, improved lipid levels, improved glucose metabolism and insulin sensitivity, modulation of gut microbiota, and enhanced vascular health. Beyond cardiometabolic outcomes, flaxseed may influence key biological processes relevant to aging, underscoring its potential to promote healthy aging and longevity. Optimal cardiometabolic benefits appear to be achieved with ground whole flaxseed at doses of ≥ 30 g/day for at least 12 weeks, particularly among individuals at high cardiometabolic risk. Future research should focus on elucidating flaxseed's mechanisms of action, clarifying its role in disease prevention, and refining dietary recommendations to harness its potential for cardiometabolic health and aging interventions.

Treating Metabolic Dysregulation and Senescence by Caloric Restriction: Killing Two Birds with One Stone?

Cellular senescence is a state of permanent cell cycle arrest accompanied by metabolic activity and characteristic phenotypic changes. This process is crucial for developing age-related diseases, where excessive calorie intake accelerates metabolic dysfunction and aging. Overnutrition disturbs key metabolic pathways, including insulin/insulin-like growth factor signaling (IIS), the mammalian target of rapamycin (mTOR), and AMP-activated protein kinase. The dysregulation of these pathways contributes to insulin resistance, impaired autophagy, exacerbated oxidative stress, and mitochondrial dysfunction, further enhancing cellular senescence and systemic metabolic derangements. On the other hand, dysfunctional endothelial cells and adipocytes contribute to systemic inflammation, reduced nitric oxide production, and altered lipid metabolism. Numerous factors, including extracellular vesicles, mediate pathological communication between the vascular system and adipose tissue, amplifying metabolic imbalances. Meanwhile, caloric restriction (CR) emerges as a potent intervention to counteract overnutrition effects, improve mitochondrial function, reduce oxidative stress, and restore metabolic balance. CR modulates pathways such as IIS, mTOR, and sirtuins, enhancing glucose and lipid metabolism, reducing inflammation, and promoting autophagy. CR can extend the health span and mitigate age-related diseases by delaying cellular senescence and improving healthy endothelial-adipocyte interactions. This review highlights the crosstalk between endothelial cells and adipocytes, emphasizing CR potential in counteracting overnutrition-induced senescence and restoring vascular homeostasis.

The role of the Mediterranean diet in reducing the risk of cognitive impairement, dementia, and Alzheimer's disease: a meta-analysis

Age-related cognitive impairment and dementia pose a significant global health, social, and economic challenge. While Alzheimer's disease (AD) has historically been viewed as the leading cause of dementia, recent evidence reveals the considerable impact of vascular cognitive impairment and dementia (VCID), which now accounts for nearly half of all dementia cases. The Mediterranean diet-characterized by high consumption of fruits, vegetables, whole grains, fish, and olive oil-has been widely recognized for its cardiovascular benefits and may also reduce the risk of cognitive decline and dementia. To investigate the protective effects of the Mediterranean diet on cognitive health, we conducted a systematic literature review using PubMed, Web of Science, and Google Scholar, focusing on studies published between 2000 and 2024. The studies included in the meta-nalysis examined the adherence to the Mediterranean diet and the incidence of dementia and AD. We applied a random-effects model to calculate pooled hazard ratios (HRs) with 95% confidence intervals (CIs) and assessed heterogeneity through I-square statistics. Forest plots, funnel plots, and Z-score plots were used to visualize study outcomes. Of the 324 full-text records reviewed, 23 studies met the inclusion criteria. The combined HR for cognitive impairment among those adhering to the Mediterranean diet was 0.82 (95% CI 0.75-0.89); for dementia, the HR was 0.89 (95% CI 0.83-0.95); and for AD, the HR was 0.70 (95% CI 0.60-0.82), indicating substantial protective effects. Significant heterogeneity was observed across studies, though Z-score plots suggested sufficient sample sizes to support reliable conclusions for each condition. In conclusion, this meta-analysis confirms that adherence to the Mediterranean diet is associated with an 11-30% reduction in the risk of age-related cognitive disorders, including cognitive impairment, dementia, and AD. These findings underscore the Mediterranean diet's potential as a central element in neuroprotective public health strategies to mitigate the global impact of cognitive decline and dementia and to promote healthier cognitive aging.