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Arterial Aging: From Endothelial Dysfunction to Vascular Calcification

J Intern Med. 2017 Mar 27. doi: 10.1111/joim.12605. [Epub ahead of print]

Tesauro M1, Mauriello A2, Rovella V1, Annicchiarico-Petruzzelli M3, Cardillo C4, Melino G2,5, Di Daniele N1.

Author information

Department of Systems Medicine, University of Rome ‘Tor Vergata’, Rome, Italy.
Department of Experimental Medicine and Surgery, University of Rome ‘Tor Vergata’, Rome, Italy.
Biochemistry Laboratory, Istituto Dermopatico Immacolata IDI-IRCCS, Rome, Italy.
Department of Internal Medicine, Catholic University, Rome, Italy.
Medical Research Council, Toxicology Unit, Leicester University, Leicester, UK.


Complex structural and functional changes occur in the arterial system with advancing age. The aged artery is characterized by changes in microRNA expression patterns, autophagy, smooth muscle cell migration and proliferation, and arterial calcification with progressively increased mechanical vessel rigidity and stiffness. With age the vascular smooth muscle cells modify their phenotype from contractile to ‘synthetic’ determining the development of intimal thickening as early as the second decade of life as an adaptive response to forces acting on the arterial wall. The increased permeability observed in intimal thickening could represent the substrate on which low-level atherosclerotic stimuli can promote the development of advanced atherosclerotic lesions. In elderly patients the atherosclerotic plaques tend to be larger with increased vascular stenosis. In these plaques there is a progressive accumulation of both lipids and collagen and a decrease of inflammation. Similarly the plaques from elderly patients show more calcification as compared with those from younger patients. The coronary artery calcium score is a well-established marker of adverse cardiovascular outcomes. The presence of diffuse calcification in a severely stenotic segment probably induces changes in mechanical properties and shear stress of the arterial wall favouring the rupture of a vulnerable lesion in a less stenotic adjacent segment. Oxidative stress and inflammation appear to be the two primary pathological mechanisms of ageing-related endothelial dysfunction even in the absence of clinical disease. Arterial ageing is no longer considered an inexorable process. Only a better understanding of the link between ageing and vascular dysfunction can lead to significant advances in both preventative and therapeutic treatments with the aim that in the future vascular ageing may be halted or even reversed.

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