Vascular memory and the erasability spectrum: reframing reversible and irreversible vascular aging

Vascular aging integrates cardiometabolic stress into persistent molecular, cellular, and structural injury, yet its variable reversibility remains poorly explained. We propose a vascular memory framework in which prior stress is stored across epigenetic, immune, mitochondrial-redox, senescent, and matrix substrates and recalled as vascular dysfunction. Their differing erasability may guide provisional endotyping and therapeutic selection, distinguish modifiable from persistent injury, and emphasize earlier, substrate-matched intervention before consolidation limits reversibility.