Heart Age and the Cardiovascular Disease Continuum: A Guide for Pharmacists

This article was sponsored by Bayer^® Aspirin.

Cardiovascular disease (CVD) is an umbrella term for a group of disorders of the heart and blood vessels, including coronary and peripheral artery disease, cerebrovascular disease, deep vein thrombosis, valve disease, and heart failure.¹ CVD affects nearly half of all US adults and is the leading cause of death in the United States, responsible for more deaths than all cancers and chronic lower respiratory diseases combined.^2,3 Coronary heart disease (39.5%), stroke (17.6%), and other related medical conditions (17.0%) account for the majority of CVD-related deaths.²

The economic burden of CVD is high. Direct health care costs for CVD comprised 11% of total US health expenditures from 2020 to 2021, and heart disease among US adults led to about $100 billion in treatment spending in 2022.^2,3 Risk factors for CVD include both nonmodifiable factors (eg, family history of heart disease) and modifiable risk factors (eg, tobacco use, physical inactivity, poor nutrition, alcohol overconsumption, overweight/obesity, high cholesterol levels, poor sleep, type 2 diabetes, and high blood pressure). Certain chronic inflammatory or autoimmune diseases also confer CVD risk.^1,2

Understanding how these risk factors contribute to CVD progression requires examining the underlying processes of vascular aging and the CVD continuum (CVDC).

Vascular Aging and the CVD Continuum

Vascular aging and arteriosclerosis, which includes ather­osclerosis and arterial stiffness, are the central underlying etiological factors of CVD that can lead to coronary and peripheral artery disease.^1,4,5

The CVDC describes a sequence of events driven by risk factors such as dyslipidemia, hypertension, diabetes, obesity, and smoking, which can ultimately lead to heart failure and death.⁶ The CVDC involves a progressive process of atherosclerotic narrowing of the coronary arteries and damage caused by myocardial ischemia and infarction.⁵

In addition to the impact of CVD risk factors and atherosclerotic progression, chronological aging itself also affects the CV system in ways that contribute to the progression of CVD.⁵ Chronological aging commonly presents as reduced endothelial function and decreased vascular elasticity.^7,8 However, CVD risk factors can accelerate vascular aging processes beyond normal chronological aging.^7,8 In patients with increased CVD risk, their vascular system ages faster than their chronological age.^4,9

The CV aging continuum begins with progressive degeneration (ie, stiffening and dilation) of the proximal aorta and progresses not only to the end stages of CVD but also to microvascular disease in richly perfused organs (Figure⁴).⁵ Both arterial narrowing and aortic stiffening contribute to the progression toward end-stage cardiac disease.⁵

Calculating Vascular Age

Vascular age represents a patient’s biological CV age compared to their chronological age. It is calculated as a patient’s age minus the difference between their estimated remaining life expectancy and the average remaining life expectancy of someone else of the same age and sex.⁹ For example, if the average remaining life expectancy of a 50-year-old man is 30 years, a 50-year-old patient whose CV risk factors reduce his life expectancy to 25 years would be estimated to have a vascular age of 55 years (50 - [25-30] →50 – [-5] = 55).⁹ This calculation makes it clear to patients that higher CV risk ages the vascular system beyond chronological age.

Importance of Early Risk Factor Awareness

CVD often originates in childhood, and the aggregate burden of CVD risk factors manifests later in life as diseases that can usually only be addressed through treating symptoms and preventing further damage.⁴ However, addressing these CVD risk factors early can arrest the progression of the CVDC.⁶

The keys to preventing and treating vascular aging are restrictive control of CV risk factors (eg, management of blood pressure and lipid levels, not smoking), adherence to a healthy diet, and physical activity. For example, reducing blood pressure helps to lower transmural wall tension and decrease arterial stiffness.⁴

The concept of vascular age can serve as a useful communication tool in discussions with patients about CVD risk that may elicit preventive lifestyle changes such as improved diet, increased physical activity, and smoking and alcohol reduction or cessation.^10,11

Communicating Heart Age to Patients: Practical Strategies for Pharmacists

Pharmacists play a central role in educating patients about their risk factors for heart disease and the importance of risk assessment and prevention. They can link heart age to modifiable behaviors to reinforce the importance of evidence-based lifestyle modification, preventive health screening, and medication adherence to treat existing conditions. For example, when counseling a patient picking up antihypertensive medication, pharmacists can explain how uncontrolled blood pressure can accelerate vascular aging and increase the patient’s heart age. At this critical moment, pharmacists can counsel the patient on the importance of adhering to daily medication regimens, as uncontrolled hypertension and some other medical conditions may not have discernible symptoms.

Pharmacists are well positioned to integrate conversations about heart age into routine encounters and to educate patients about the importance of consulting with primary care providers, cardiologists, dietitians, and community resources. Through these efforts, pharmacists empower patients to proactively manage their health and contribute to improved CV outcomes.

REFERENCES

1. Cardiovascular disease. Cleveland Clinic. Updated September 1, 2022. Accessed November 24, 2025. https://my.clevelandclinic.org/health/diseases/21493-cardiovascular-disease
2. 2025 Heart disease and stroke statistics update fact sheet. American Heart Association. 2025. Accessed November 24, 2025. https://www.heart.org/en/-/media/PHD-Files-2/Science-News/2/2025-Heart-and-Stroke-Stat-Update/2025-Statistics-At-A-Glance.pdf?sc_lang=en
3. Moriya AS, Berdahl T. Healthcare expenditures for heart disease among adults aged 18 and older in the U.S. civilian noninstitutionalized population, 2022. Statistical Brief #562. AHRQ publication no. 25-0056. July 2025. Agency for Healthcare Research and Quality. https://meps.ahrq.gov/data_files/publications/st562/stat562.pdf
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10. Cuende JI, Cuende N, Calaveras-Lagartos J. How to calculate vascular age with the SCORE project scales: a new method of cardiovascular risk evaluation. Eur Heart J. 2010;31(19):2351-2358. doi:10.1093/eurheartj/ehq205
11. Jamthikar A, Gupta D, Cuadrado-Godia E, et al. Ultrasound-based stroke/cardiovascular risk stratification using Framingham Risk Score and ASCVD Risk Score based on “integrated vascular age” instead of “chronological age”: a multi-ethnic study of Asian Indian, Caucasian, and Japanese cohorts. Cardiovasc Diagn Ther. 2020;10(4):939-954. doi:10.21037/cdt.2020.01.16