Chronological and biological age in elderly cardiological patients: pathophysiological mechanisms, assessment methods, and clinical significance of disparity

Chronological age remains one of the most important determinants of cardiovascular risk; however, in elderly and senile cardiac patients it does not always reflect the individual rate of aging, functional reserves and pathophysiological vulnerability of the cardiovascular system. Biological age is considered an integrative characteristic of the aging rate formed under the influence of cellular senescence, chronic low-grade inflammation, endothelial dysfunction, mitochondrial impairment, epigenetic drift, arterial stiffness, metabolic disorders and reduced compensatory reserves of the body [1–4, 20–25]. In older cardiac patients, the discrepancy between chronological and biological age has important prognostic significance, as it allows identification of patients with accelerated vascular, metabolic, myocardial and functional aging, refinement of cardiovascular risk, assessment of tolerance to therapy and invasive interventions, and individualization of therapeutic strategy [3, 5–7, 18, 30, 31]. This review systematizes current concepts of the differences between chronological and biological age, considers the pathophysiological mechanisms of accelerated cardiovascular aging, and describes clinicalfunctional, laboratory-phenotypic, epigenetic and instrumental methods for assessing biological age. Special attention is paid to the interpretation of situations in which biological age exceeds chronological age or, conversely, is lower than it. It is shown that the most justified approach is not the isolated use of a single biomarker, but a multimodal assessment combining comprehensive geriatric evaluation, laboratory parameters, markers of vascular aging and, where available, epigenetic clocks [5–8, 28, 29].