Cardiovascular aging through the lens of Blue Zones

Blue Zones are geographically distinct populations characterized by exceptional longevity and remarkably low rates of cardiovascular disease. Although these regions differ culturally and environmentally, they share common lifestyle patterns, including habitual natural physical activity, predominantly plant-based diets, caloric moderation, strong social integration, stress reduction, and purpose-driven living. In this review, we examine the cardiovascular phenotype of Blue Zone populations and discuss the biologic mechanisms through which these lifestyle patterns may influence vascular aging, metabolic health, and longevity. We summarize emerging evidence linking Blue Zone-associated behaviors to improved endothelial function, reduced arterial stiffness, mitochondrial quality control, attenuation of chronic inflammation, and preservation of metabolic flexibility. Focus is placed on nutrient-sensing pathways involving adenosine monophosphate-activated protein kinase, Sirtuin 1, Forkhead box O signaling, and mTOR(definition), as well as mechanisms related to autophagy(definition), oxidative stress, inflammation, endothelial homeostasis, and cellular aging. We further review evidence regarding immune regulation, epigenetic aging, telomere(definition) stability, and longevity-associated biomarkers observed in centenarian populations. Finally, we discuss the translational implications of the Blue Zones framework for preventive cardiology and public health, including the development of culturally adaptable lifestyle interventions to extend health span and reduce the burden of cardiovascular and age-related disease.