Ageing is the main risk factor for the development of cardiovascular diseases. A central
mechanism by which ageing promotes vascular pathologies is compromising endothelial
health. The age-related attenuation of endothelium-dependent dilator responses (endothelial
dysfunction) associated with impairment of angiogenic processes and the subsequent
pathological remodelling of the microcirculation contribute to compromised tissue
perfusion and exacerbate functional decline in older individuals. This Review focuses
on cellular, molecular, and functional changes that occur in the endothelium during
ageing. We explore the links between oxidative and nitrative stress and the conserved
molecular pathways affecting endothelial dysfunction and impaired angiogenesis during
ageing. We also speculate on how these pathological processes could be therapeutically
targeted. An improved understanding of endothelial biology in older patients is crucial
for all cardiologists because maintenance of a competently functioning endothelium
is critical for adequate tissue perfusion and long-term cardiac health.
