A five-author team from Cooper Medical School of Rowan University argues that chronological age is a poor stand-in for how well a patient will tolerate surgery, and that “vascular age” measured mainly by carotid-femoral pulse wave velocity should replace or supplement it in perioperative risk stratification. The authors review how hypertension, coronary artery disease, and heart failure with preserved ejection fraction each drive early vascular aging through a shared triad of endothelial dysfunction, oxidative stress, and chronic low-grade inflammation, and they assert that these conditions can shift a person’s arterial profile forward by five to twenty years. They then propose practical implications for anaesthesia: tighter blood pressure targets, slower titration of vasoactive drugs, and restraint with crystalloid fluids in patients whose arteries are stiffer than their birth certificate would predict.
There is a number on your chart that says how old you are, and there is a number in your aorta that says how old you actually are. A mini review published in Frontiers in Cardiovascular Medicine in May 2026 makes the case that surgeons and anaesthesiologists have been reading the wrong one.
The big idea is not new, but the framing is. Vascular aging is the progressive stiffening of the large arteries as elastin fragments, collagen accumulates, and the endothelium loses its ability to modulate tone. In some people this happens on schedule. In others, described in the literature as early vascular aging, it runs years or decades ahead. The authors point out that the same measurement used in cardiology to predict long-term mortality, carotid-femoral pulse wave velocity, also describes something more immediate: how much physiological slack a patient has when a surgeon opens them up.
Stiff arteries do not buffer. A compliant aorta absorbs each ventricular ejection and releases it smoothly. A stiff one transmits the pulse straight through, sending damaging pulsatile energy into low-resistance organs, particularly the kidneys and brain, and leaving blood pressure hypersensitive to the fluid shifts, blood loss, and vasoactive drugs that define an operation. The authors argue this explains a pattern clinicians already recognise anecdotally: the 55-year-old with long-standing hypertension who behaves haemodynamically like a 75-year-old, develops acute kidney injury after a routine case, and heals slowly.
They walk through three accelerators. Hypertension, through mechanical stress and renin-angiotensin-aldosterone driven oxidative injury, is claimed to add five to ten years of vascular age when well controlled and ten to fifteen when not. Coronary artery disease, via oxidised LDL, foam cell formation, and microvascular dysfunction, is put at ten to twenty years. Heart failure with preserved ejection fraction is reframed not as a disease of stiff ventricles but as a vascular syndrome, in which arterial load and poor ventricular-arterial coupling starve the myocardium of reserve exactly when a surgical stressor demands it.
The proposal is modest and sensible: measure stiffness before surgery, then manage the patient to their arterial age rather than their calendar age.
Actionable Insights
The measurement worth knowing is carotid-femoral pulse wave velocity, how fast your pulse travels down your aorta. Healthy values run near 6.2 metres per second under age 30, 7.2 in your forties, 10.9 past 70. Faster means stiffer. Above roughly 10, your arteries resemble those of someone one to two decades older.
It predicts hard outcomes. Across 15,877 people, each 1 metre per second increase carried about 15 percent higher all-cause mortality risk, and the stiffest group died at roughly twice the rate of the least stiff. That is an association, not proof that softening arteries saves you.
What moves the number is exercise. Across 69 randomised trials and 3,422 people, training lowered stiffness by 0.74 metres per second, aerobic work by 0.85. That is roughly a 0.3 to 0.5 standardised effect, visible in a group but not necessarily in yourself, and worth about four to eight years of arterial age depending on where you start. Benefit appeared above roughly 350 MET-minutes per week, about 90 minutes of brisk activity. Resistance training alone did not reach significance.
Before surgery, blood pressure control matters most. If you have hypertension, coronary disease, or diastolic heart failure, this paper’s advice to your anaesthesiologist is narrower pressure targets and less aggressive fluid loading.
Context and Source
- Open Access Paper: Vascular age vs. chronological age in operative risk stratification.
- Institution: Cooper Medical School of Rowan University and Department of Anesthesiology, Cooper University Hospital, Camden, New Jersey, United States.
- Journal: Frontiers in Cardiovascular Medicine.
- Article type: Mini Review.
- Journal impact evaluation: The impact score of this journal is 3.0 (2025 Journal Impact Factor; Scopus CiteScore approximately 6.1, ranking 90 of 409 in Cardiology and Cardiovascular Medicine; Web of Science quartile Q2, rank 93 of 237 in Cardiac and Cardiovascular Systems), evaluated against a typical high-end range of 0 to 60+ for top general science and medical journals, therefore this is a Medium impact journal.
!