Many individuals do not appear to have matching chronological and biological age, as evaluated by their general outlook, physical examination, or clinical investigations. One aspect of this is the concept of early vascular ageing. This could be useful both in research and clinical practice to understand and treat the increased cardiovascular risk in many patients, e.g. with hypertension in poor control. New ways of measuring biological ageing have been introduced, for example telomere length (“mitotic senescence”) that has now been explored in observational studies, and is promising to use also to evaluate biological effects in intervention studies. If the process of vascular ageing could be better understood, as well as its genetic and environmental correlates, new and better ways of offering preventive strategies to risk individuals could be formed. Smoking cessation is one of the classical ways to counteract biological and vascular ageing, but a variety of drugs could also be of potential importance in this respect, e.g. statins, blockers of the renin-angiotensin system, metformin and glitazones. This has to be evaluated in prospective studies, but pravastatin has already been shown to attenuate the associate between short telomere length and risk of coronary heart disease in the WOSCOP study in high-risk Scottish men.