Why Do Blue Zone Populations Live Longer? Mechanistic Insights Into Cardiovascular Longevity

Growing interest in Blue Zone populations and a focus on cardiovascular protection are leading to significant discoveries about human longevity. These regions-Okinawa, Sardinia, the Nicoya Peninsula, Ikaria, and Loma Linda-are characterized by a high prevalence of centenarians and relatively low rates of cardiovascular mortality. Despite cardiovascular disease remaining the leading global cause of morbidity and mortality, its relationship with exceptional longevity remains incompletely understood. Much of the existing literature on Blue Zones is descriptive, with limited integration of cardiovascular epidemiology and the biological mechanisms underlying healthy cardiac aging. This narrative review aims to bridge this gap by examining key cardiovascular features associated with longevity, including vascular aging, myocardial remodeling, and autonomic regulation. In addition, we explore mechanistic pathways derived from centenarian studies, such as reduced inflammation, enhanced metabolic efficiency, and favorable neurohormonal balance, to better understand how these factors collectively shape a distinct cardiovascular aging trajectory. By integrating epidemiological patterns with mechanistic insights, this work seeks to provide a more comprehensive framework for understanding cardiovascular longevity and its potential translation into preventive cardiology.