Aging is the key risk factor for most diseases, yet underlying mechanisms remain incompletely understood. The recently published Nature Reviews Cardiology Roadmap—authored by a distinguished group of experts, including many members of our working group—delivers the first comprehensive framework to address this urgent unmet need.

Indeed, this landmark paper delves into the cellular and molecular hallmarks of cardiovascular aging, from endothelial dysfunction and vascular stiffening to mitochondrial decline, chronic inflammation, and immune dysregulation. It highlights how these intricate pathways are interconnected and by which mechanisms they contribute to age-related diseases, such as atherosclerosis, heart failure, and vascular dementia. Importantly, the authors identify knowledge gaps that hinder clinical translation and outlines novel strategies how to overcome this hurdles in the future.

Beyond pathophysiology, we outline promising gerotherapeutic interventions, including metabolic modulators, senolytics, and mitochondria-targeted therapies. We advocate the importance of lifestyle interventions—physical exercise, caloric restriction, and intermittent fasting—in slowing cardiovascular decline. Finally, we emphasize the need for novel clinical trial designs incorporating biomarkers of biological aging to assess interventions beyond traditional risk factors.

We hope this Nature Roadmap will serve as a valuable guide for researchers and clinicians, fostering new strategies to delay cardiovascular aging and improve healthspan.