Supplemental Digital Content is available in the text. Pulse wave velocity is an established marker of early vascular aging but may also help identifying individuals with supernormal vascular aging. We tested the hypothesis that individuals with the largest difference (Δ-age) between chronological and vascular age show the lowest rate of cardiovascular events and may thus be defined as supernormal vascular aging. Vascular age was defined as the predicted age in the best fitting multivariable regression model including classical risk factors and treatment and pulse wave velocity, in a subset of the Reference Values for Arterial Stiffness Collaboration Database (n=3347). Δ-age was then calculated as chronological age minus vascular age, and the 10th and 90th percentiles were used to define early (Δ-age<−5.7 years), normal (Δ-age −5.7 to 6.8 years) and supernormal vascular aging (Δ-age>6.8 years). The risk for fatal and nonfatal cardiovascular events associated with vascular aging categories was investigated in the Malmö Diet and Cancer Study cohort (n=2642). In the Malmö Diet and Cancer Study Cohort (6.6-year follow-up, 286 events), Δ-age was significantly (P<0.01) and inversely associated with cardiovascular events. Compared with normal vascular aging, supernormal vascular aging had lower risk (hazard ratio, 0.59 [95% CI, 0.41–0.85]), whereas early vascular aging had higher risk (hazard ratio, 2.70 [95% CI, 1.55–4.70]) of cardiovascular events, in particular coronary events. There was no significant association with all-cause mortality. This study represents the first validation of the clinical significance of the supernormal vascular aging concept, based on prospective data. Its further characterization may help discovering novel protective molecular pathways and providing preventive strategies for successful vascular aging.

中文翻译：

---

早期和超常血管老化

补充数字内容在文本中可用。脉搏波速度是早期血管老化的既定标志，但也可能有助于识别具有超常血管老化的个体。我们检验了以下假设：实足年龄和血管年龄之间差异最大（Δ-年龄）的个体的心血管事件发生率最低，因此可能被定义为超常血管老化。血管年龄被定义为最佳拟合多变量回归模型中的预测年龄，包括经典风险因素和治疗以及脉搏波速度，在动脉僵硬度协作数据库的参考值子集中 (n=3347)。然后将 Δ-年龄计算为实足年龄减去血管年龄，第 10 和第 90 个百分位数用于定义早期（Δ-年龄<-5.7 岁）、正常（Δ-年龄 -5.7 至 6. 8 岁）和超常血管老化（Δ-age>6.8 岁）。在马尔默饮食和癌症研究队列 (n=2642) 中调查了与血管老化类别相关的致命和非致命心血管事件的风险。在马尔默饮食和癌症研究队列（6.6 年随访，286 次事件）中，Δ-年龄显着（P<0.01）与心血管事件呈负相关。与正常血管老化相比，超常血管老化的风险较低（风险比，0.59 [95% CI，0.41-0.85]），而早期血管老化的风险更高（风险比，2.70 [95% CI，1.55-4.70]）心血管事件，特别是冠状动脉事件。与全因死亡率没有显着相关性。根据前瞻性数据，这项研究首次验证了超常血管老化概念的临床意义。