Clusters of vascular aging manifestations predict incident cardiovascular events in the community

Vascular aging is the accumulation of functional and structural changes of vessels throughout life. While earlier studies have shown that single manifestation of vascular aging is associated with an increased risk of cardiovascular disease (CVD), it is unknown how the different manifestations of vascular aging cluster at the individual level, and whether individuals with different vascular aging patterns have different risk of progression to overt CVD. Here, we identify three patterns of vascular aging including healthy vascular aging (HVA), arteriosclerosis and atherosclerosis. Vascular aging manifestations were evaluated non-invasively by carotid ultrasound methods. The main and the validation analysis were conducted on 8360 and 2086 participants in two separate prospective cohorts. We find that arteriosclerosis and atherosclerosis compared to HVA clusters are independent predictors of CVD, and improve risk stratification for stroke among those at intermediate risk. Vascular aging evaluation may help identify those at increased risk of CVD. How the multiple manifestations of vascular aging cluster and predict overt cardiovascular disease (CVD) is unknown. Here, the authors identify three patterns of vascular aging, showing their independent association with incident CVD, and their added value for stroke risk stratification.