Vascular aging biomarkers: the role of ADMA, SDMA, and inflammation

Cardiovascular risk assessment based on traditional risk factors may not fully capture subclinical vascular injury and vascular aging, supporting interest in biomarkers reflecting underlying vascular mechanisms. Endothelial dysfunction, altered methylarginine metabolism, and chronic low-grade inflammation represent interconnected processes that may contribute to vascular aging. This narrative review summarizes evidence on the associations of asymmetric dimethylarginine, symmetric dimethylarginine, interleukin-6, and high-sensitivity C-reactive protein with subclinical atherosclerosis and vascular aging. PubMed and Google Scholar were searched between January and August 2026, with priority given to studies evaluating associations of these biomarkers with subclinical vascular changes, vascular aging, and cardiovascular outcomes. ADMA shows the most consistent associations with subclinical atherosclerosis, although these vary across arterial territories and vascular measures. Evidence for SDMA in early vascular disease is more limited, and interpretation is complicated by its dependence on renal function, although some associations persist after adjustment for renal function. IL-6 has biological and genetic evidence supporting a role in atherogenesis, but its associations with subclinical atherosclerosis are not consistently independent of traditional cardiovascular risk factors. hsCRP is an established cardiovascular risk marker and has also been associated with progression of carotid stenosis and arterial stiffness. Differences in vascular endpoints, study populations, confounder adjustment, and analytical methods contribute to heterogeneity across studies. Overall, these biomarkers appear to reflect partly distinct but interconnected components of vascular aging. Their potential relevance may lie in their complementarity; however, current evidence does not establish that combined assessment improves evaluation beyond conventional approaches. Prospective studies should determine whether their combined assessment improves identification of accelerated vascular aging beyond conventional risk assessment.