Background: The endothelium plays an important role in cardiovascular regulation,
from blood flow to platelet aggregation, immune cell infiltration and demargination. A dysfunctional
endothelium leads to the onset and progression of Cardiovascular Disease (CVD). The aging
endothelium displays significant alterations in function, such as reduced vasomotor functions and
reduced angiogenic capabilities. This could be partly due to elevated levels of oxidative stress and
reduced endothelial cell turnover. Circulating angiogenic cells, such as Endothelial Progenitor Cells
(EPCs) play a significant role in maintaining endothelial health and function, by supporting endothelial
cell proliferation, or via incorporation into the vasculature and differentiation into mature
endothelial cells. However, these cells are reduced in number and function with age, which may
contribute to the elevated CVD risk in this population. However, lifestyle factors, such as exercise,
physical activity obesity, and dietary intake of omega-3 polyunsaturated fatty acids, nitrates, and
antioxidants, significantly affect the number and function of these circulating angiogenic cells.
Conclusion: This review will discuss the effects of advancing age on endothelial health and vascular
regenerative capacity, as well as the influence of diet, exercise, and obesity on these cells, the
mechanistic links and the subsequent impact on cardiovascular health.