Beyond chronological age: identifying accelerated aortic aging through laboratory indicators and geometric phenotyping
X Duan, S H Yu, Q Y Hu, X L Du, T Yang, X D Jin, C D LiaoAbstract
Background
The thoracic aorta undergoes significant geometric remodeling with age, which is linked to cardiovascular diseases. However, systematic aging patterns across multiple aortic geometric phenotypes (AGPs) and the potential of routine laboratory tests to reflect aortic "accelerated aging" remain incompletely understood.
Purpose
We aim to systematically evaluate age-related changes in thoracic aortic geometry, assess the independent impact of cardiovascular risk factors, and identify routine laboratory markers associated with accelerated vascular aging.
Methods
This retrospective cross-sectional study included 1,971 subjects (1,348 females, 623 males; mean age 40.1 ± 10.6 years) in our institution from January 2025 to February 2025. Using non-electrocardiography (ECG)–gated chest CT, 27 AGPs were extracted. Multivariable linear regression was used to evaluate the effects of age, sex, and four cardiovascular risk factors (hypertension, diabetes, smoking, hyperlipidemia) on AGPs. Aortic "accelerated aging" was defined as geometric changes exceeding age- and sex-expected values (model residuals), which were subsequently analyzed against 46 routine laboratory indicators using regression and SHAP analyses.
Results
Among 1,887 eligible subjects, aortic allometric volume (standardized β = 0.665/decade; highest mean |SHAP| = 6.38) and mean diameters demonstrated the strongest associations with chronological aging, accompanied by progressive aortic straightening. After adjusting for age and sex, hypertension emerged as the most significant independent driver of geometric remodeling, notably expanding diameters, volume, and arch width (all p < 1×10-6). The impact of smoking was substantially attenuated after age adjustment. Furthermore, higher high-density lipoprotein cholesterol (HDL-C) was independently associated with less-than-expected aortic dilation, whereas elevated fasting glucose, total cholesterol, and inflammatory markers were significantly linked to accelerated aortic aging (FDR < 0.05).
Conclusions
Allometric volume and diameter are highly sensitive markers for thoracic aortic aging. Hypertension independently accelerates geometric remodeling, whereas smoking's impact is largely mediated by overall aging. Routine metabolic and inflammatory laboratory panels can facilitate the early identification of accelerated vascular aging.Disease&agpFor image description, please refer to the figure legend and surrounding text.Lab&agpFor image description, please refer to the figure legend and surrounding text.