Cardiovascular health and longevity: where are we?

Cardiovascular health is a key factor in human longevity, affecting not just lifespan but also the quality of aging. We synthesize evidence across four risk factor domains: genetic and epigenetic factors (APOE, FOXO3, telomere biology, epigenetic clocks); metabolic and vascular factors (hyperglycemia, dyslipidemia, obesity, arterial stiffness); lifestyle determinants (diet, physical activity, smoking, sleep, gut microbiome); and environmental exposure (air and noise pollution, climate stressors, ionizing radiation). These factors influence various biological processes such as oxidative stress, chronic low grade inflammation (inflammaging), mitochondrial dysfunction, metabolic disturbances, and changes in telomere length and epigenetics that collectively damage the endothelium, stiffen arteries, promote atherosclerosis, and contribute to overall cardiovascular decline with age. Understanding these processes helps explain why cardiovascular aging is such a strong predictor of mortality. We further summarize the principal intervention strategies with evidence for improving cardiovascular health and longevity, such as adherence to the American Heart Association's Life's Essential 8 construct, heart-healthy dietary patterns(Mediterranean, DASH), smoking cessation, sleep optimization, and reduction of environmental exposures. This narrative review distinguishes evidence derived from model organisms, human observational cohorts, and human interventional/genetic studies, since these evidence tiers differ substantially in their support for lifespan or longevity extending claims specifically, as opposed to cardiovascular risk reduction more broadly.