Nature reviews. CardiologyOct 26, 2026

Heart and blood vessel strength in people aged 100 and older

Longevity & Aging Weekly Brief ↗PubMed ↗DOI ↗

Updated Oct 27, 2026

Abstract

Centenarians often experience cardiovascular diseases later than individuals aged 80-100 years.

Despite common cardiovascular and metabolic diseases, centenarians typically show delayed onset compared to younger older adults.
Structural heart and vessel changes in centenarians include concentric left ventricular remodeling and increased myocardial stiffness, yet they often lack severe heart failure.
Centenarians generally maintain a favorable cardiometabolic profile, with preserved insulin sensitivity and low rates of diabetes, obesity, and mid-range lipid levels.
They exhibit chronic low-grade inflammation alongside elevated anti-inflammatory signaling and possess a gut microbiome resembling that of younger adults.
Genetic and epigenetic factors contribute significantly to exceptional longevity, characterized by polygenic influences and younger epigenetic age.

Simplified

Centenarians - individuals aged ≥100 years - provide a unique human model for understanding resilience to cardiovascular ageing. Although cardiovascular and metabolic diseases, including hypertension, heart failure, atrial fibrillation and chronic kidney disease, are common in centenarians, their onset is typically delayed relative to that in individuals aged 80-100 years. Centenarians characteristically have structural changes in the heart and vessels, including concentric left ventricular remodelling, increased myocardial stiffness and vascular ageing, but often without the expected burden of myocardial infarction or overt heart failure. Their cardiometabolic profile is generally favourable, marked by preserved insulin sensitivity in cohorts with a low prevalence of diabetes mellitus, mid-range lipid levels and a low prevalence of obesity. Centenarians also have a distinctive inflammatory and gastrointestinal phenotype, characterized by chronic low-grade inflammation with elevated anti-inflammatory signalling, a gut microbiome that more closely resembles that of younger adults, and preserved intestinal barrier integrity. Genetically and epigenetically, exceptional longevity reflects highly polygenic contributions, selective maintenance of genomic stability and markedly younger epigenetic age compared with chronological age. In this Review, we summarize data on the cardiovascular system among centenarians by framing observations of longevity as a composite of delayed pathology, adaptive compensation and survivorship selection. Understanding the biological, behavioural and environmental mechanisms underlying cardiovascular resilience in extreme longevity might inform strategies to extend cardiovascular healthspan across all ages.

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Heart and blood vessel strength in people aged 100 and older

Abstract

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