基于血管衰老的老年心脑血管疾病中医药防治进展

Advances in Traditional Chinese Medicine for the Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases in Older Adults Based on Vascular Aging

摘要: 从血管衰老视角探讨老年心脑血管疾病的共同病理基础及中医病机，并总结中医药防治研究进展。血管衰老以血管内皮功能障碍、血管壁重塑、动脉僵硬及微循环障碍等为主要特征，是老年高血压、冠心病及缺血性脑卒中的重要共同病理基础。中医学虽无“血管衰老”之名，但年老正虚、痰瘀内生、脉络不利等认识与其病理演变具有一定契合性，部分疾病迁延过程中还可出现痰瘀化毒、毒损脉络。现有研究表明，中医药可从延缓血管细胞衰老与结构重塑、改善内皮功能及微循环等环节发挥血管保护作用，涉及线粒体稳态、氧化应激、炎症反应及细胞代谢等机制。表观遗传调控、肠道菌群及其代谢等新兴方向进一步拓展了相关机制研究，但目前仍以基础研究为主，直接反映血管衰老的临床评价及高质量临床证据相对不足。从血管衰老视角整合不同老年心脑血管疾病的中医病机与干预证据，有助于深化“异病同机、异病同治”的理论认识，并为中医药防治老年心脑血管疾病提供新的研究思路。

Abstract: This review examines the shared pathological basis and traditional Chinese medicine (TCM) pathogenesis of cardiovascular and cerebrovascular diseases in older adults from the perspective of vascular aging and summarizes recent advances in TCM-based prevention and treatment. Vascular aging is primarily characterized by endothelial dysfunction, vascular wall remodeling, arterial stiffness, and microcirculatory dysfunction, and represents an important shared pathological basis for hypertension, coronary heart disease, and ischemic stroke in older adults. Although there is no direct equivalent of “vascular aging” in TCM, the concepts of age-related deficiency, endogenous phlegm and blood stasis, and impaired collateral circulation show certain parallels with its pathological progression. In some diseases, prolonged phlegm and blood stasis may further transform into pathogenic toxins and damage the collaterals. Current evidence suggests that TCM may exert vascular protective effects by delaying vascular cellular senescence and structural remodeling and by improving endothelial function and microcirculation, involving mechanisms such as mitochondrial homeostasis, oxidative stress, inflammatory responses, and cellular metabolism. Emerging areas, including epigenetic regulation and the gut microbiota and its metabolites, have further expanded the mechanistic perspectives on TCM interventions for vascular aging. However, current evidence is still largely derived from basic research, while clinical assessments that directly reflect vascular aging and high-quality clinical evidence remain limited. Integrating the TCM pathogenesis and intervention evidence for different cardiovascular and cerebrovascular diseases in older adults from the perspective of vascular aging may deepen the understanding of the TCM concepts of “different diseases sharing the same pathogenesis” and “treating different diseases with the same method,” and provide new perspectives for the prevention and treatment of cardiovascular and cerebrovascular diseases in older adults with TCM.