CHANGES IN VASCULAR AGE IN PATIENTS WITH HEART FAILURE

Аннотация

Chronic heart failure (ChHF) is a complex syndrome accompanied by a decrease in the pumping function of the heart, causing long-term loading and structural- functional changes in the cardiovascular system. In recent years, the concept of” vascular age " — the level of biological aging of the vessels — has emerged as an important biomarker that determines the prognosis of the disease in patients with SYY. Faster aging of the vessels compared to the passport age leads to an increase in cardiac load, a deepening of diastolic dysfunction and a risk of cardiac remodeling. This narrative analytical article highlights the essence of vascular age, methods for its assessment, (pulse wave rate, arterial stiffness) and its clinical significance on the topic of heart failure on the basis of recent scientificliterature. Keywords: heart failure, vascular age, arterial stiffness pulse wave rate, cardiac remodeling, biological aging Introduction. Heart failure is a syndrome characterized by the inability of the heart to release blood to the extent that the body needs, and is one of the leading causes of death among cardiovascular disease. The development of ChHF is closely related not only to changes in the heart muscle, but also to aging and stiffness processes in vessels, especially large arteries. In this regard, the concept of” vascular age " is gaining relevance in clinical practice. Vascular age is an indicator that reflects the biological aging level of a patient’s arteries independently of their actual (chronological) age. Arterial stiffness, endothelial dysfunction, disruption of the collagen/elastin ratio, inflammation, and oxidative stress factors reduce the elasticity of the vascular wall and increase vascular age. In patients with heart failure, the increase in vascular age intensifies the systolic load on the heart, accelerates myocardial hypertrophy and remodeling, which leads to disease progression and worsens response to therapy. Pulse wave velocity (PWV) is the primary and most widely used marker for assessing vascular age. It allows evaluation of arterial wall elasticity by measuring the speed of the heart’s pulse wave propagation along the aorta. This article is devoted to a detailed analysis of the significance of vascular age in patients with heart failure, the criteria for its determination, andits diagnosticvalue. Vascular age is an integrative biomarker that reflects the biological aging status of the human vascular system—primarily the aorta and large elastic arteries—and it does not always correspond to the patient’s chronological age. This indicator depends on the structural and functional condition of the arterial wall, namely elasticity, the collagen/elastin ratio, endothelial function, and arterial stiffness. In particular, vascular stiffness measured by pulsewavevelocity is considered the mostreliable method forassessing vascular age. 98,7:ROTCAFTCAPMI.SECNEICS LACIDEM ,5202, enuJ,5emuloV gro.srehsilbupcimedaca.www When analyzing the clinical types of vascular age, it is generally compared to the patient’s chronological (passport) age and corresponds toone ofthefollowing three categories: The first is normal vascular age — in this case, the patient’s vascular system ages proportionally to their chronological age. In other words, the arteries biologically retain elasticity consistent with those of individuals of the same chronological age. Such individualstypically have an average risk ofcardiovascular diseases. The second is supernormal vascular age — here, the arteries appear significantly “younger” relative to the chronological age, meaning they remain elastic, healthy, and functionally active. This condition is commonly observed in individuals who engage in regular physical activity, athletes, or those who adhere to a healthy lifestyle. These individuals have a substantiallyreduced risk of heart failure and atheroscleroticcardiovascular diseases. The third is premature vascular aging (PVA) — in this scenario, the arteries age considerably faster than the patient’s actual age; that is, the biological vascular age exceeds the chronological age by 5 to 10 years. PVA is primarily associated with hypertension, diabetes mellitus, metabolic syndrome, dyslipidemia, and chronic inflammatory processes. This condition markedly increases the risk of heart failure development, especially playing a pivotal role in diastolic dysfunction and heart failure with preserved ejection fraction (HFpEF). Therefore, these three clinical patterns of vascular age serve as critical indicators for evaluating cardiovascular health, guiding preventive strategies, and monitoring therapeutic outcomes. This approach is supported by numerous reputable studies. For example, Ben-Shlomo et al. (JACC, 2014), in their meta-analysis, demonstrated that patients with a pulse wave velocity (PWV) above 10 m/s have a twofold increased risk of cardiovascular diseases. Boutouyrie and Laurent (Nat Rev Cardiol, 2021) identified a close a