Bidirectional associations between biological aging, cardiovascular health, and cardiovascular risk: findings from the INSPIRE-T lifespan cohort

Chronological age is a common and non-modifiable factor for chronic disease, but does not fully explain age-related changes. Biological clocks have been developed to explore biological aging mechanisms. They could help identify protective factors against accelerated aging and associated diseases. We aim to assess the association between reduced epigenetic or inflammatory aging and ideal cardiovascular health or cardiovascular risk. We conducted a cross-sectional analysis of participants from the INSPIRE-T cohort. Cardiovascular health (CVH) was assessed using the Life's Essential 8 score. Cardiovascular risk was assessed using the American Framingham risk score (FRS) and the European Systematic Coronary Risk Evaluation (SCORE2) score. Epigenetic and inflammatory aging was calculated from the residuals from linear regression of biological age (based on five epigenetic clocks and one inflammatory clock) and chronological age. Linear and logistic regression models were used. Better CVH has been associated with slower epigenetic aging, particularly in younger subjects and men. Accelerated epigenetic aging measured by GrimAge was associated with an increase cardiovascular risk (for SCORE2: OR = 1.10 95%CI [1.04; 1.16]). No persistent association was found with the inflammatory clock. Our study reported an association between ideal global CVH with reduced epigenetic aging after adjustment for chronological age and gender. This suggests that epigenetic aging may be modifiable through healthy lifestyle and cardiovascular risk management, although a potential underlying causal relationship remains to be established. Moreover, accelerated epigenetic aging is linked to worsening cardiovascular risk, and could be a new risk factor alongside chronological age.