Pathogenesis and pathobiology of imaging vascular biomarkers during the aging process: a narrative review

The vasculature is a highly complex organ system capable of sensing alterations in its surroundings, promptly transducing signals to vascular and surrounding tissue cells, and synthesizing local mediators that induce both acute and chronic functional and structural adaptive responses. Vascular aging (VA) results from the combined effects of congenital and acquired risk factors and their interactions, and is a natural and inevitable contributor to age-related cardiovascular (CV) diseases. Atherosclerosis, arterial hypertension, and other CV diseases progressively lead to vascular dysfunction through multiple consecutive and interconnected pathological processes, including oxidative stress with reactive oxygen species (ROS) formation, endothelial dysfunction, mitochondrial dysfunction, systemic inflammation, and autophagy. As molecular and signal transduction mechanisms become increasingly central to understanding vascular disease pathology—and as the interplay between basic science and clinical experience often yields counterintuitive findings—this narrative review summarizes the pathological changes of VA, tracing the process from the cellular level to clinically manifest vascular disorders, and describes in detail the most important imaging markers of the aging process. Furthermore, the review examines the essential mechanisms of vascular aging–related dysfunction from a fresh mechanistic perspective, aiming to inform and optimize the development of novel treatment strategies for patients with age-related CV diseases.