Elderly escapers from cardiovascular complications and death despite high arterial stiffness: why are they protected?

Background: Individuals with high pulse wave velocity (PWV) may suffer from early vascular ageing (EVA) and face increased cardiovascular risk. Nonetheless, some individuals with EVA survive until old age, some even escaping cardiovascular complications entirely. The aim of this study was to explore characteristics of such individuals in population-based cohorts. Methods: We used data from the Metabolic syndrome and Artery REsearch (MARE) Consortium and a MARE sub-cohort; the Malmö Diet Cancer Study – Cardiovascular (MDCS-CV) arm for analyses, both covering cardiovascular risk factors, PWV, and carotid intima–media thickness (cIMT). EVA survivors (individuals 75+ years; PWV ≥ 90th percentile for age strata), were compared to age-matched and sex-matched controls (PWV 0 to 75th percentile). Additionally, in MDCS-CV, prospective EVA escapers without major adverse cardiovascular events (MACE) or death during 10-year follow-up, were compared to EVA nonescapers. Results: EVA Elderly survivors in the MARE Consortium had a higher risk factor burden, including cIMT levels, compared to controls. In MDCS-CV, similar patterns were found; however, cIMT did not differ between EVA Elderly survivors and controls, despite higher mean PWV (17 vs. 11 m/s). Finally, in MDCS-CV, EVA Elderly escapers ( n = 34) compared to nonescapers ( n = 56) had lower mean cIMT (0.92 vs. 1.01 mm; P = 0.009), despite comparable PWV (17 vs. 16 m/s). No other group differences were observed. Conclusion: EVA elderly survivors and escapers exist even among the very elderly. The latter are characterized by lower cIMT than EVA Elderly nonescapers. This could indicate discordant (differentiated) arterial ageing to be further explored.