Authors: Marek Postula, & Svjatoslavs Kistkins, Anna Nowak-Szwed, Salvatore DeRosa, Karol Kaminski, Anna Erat, Uģis Klētnieks, Othmar Moser, Dmitrijs Bliznuks, Ilia Stambler, Emīls Sjundjukovs, Jaron Rabinovici, Morten Scheibye-Knudsen, Alex Zhavoronkov, Vadim N. Gladyshev, Steve Horvath, Bruno Vellas, George A. Kuchel, Harald Sourij, Evelyne Bischof, Andreas F.H. Pfeiffer. DOI: https://doi.org/10.14336/AD.2026.0279

Abstract

This Delphi-derived expert consensus provides a clinical framework to optimize and maintain healthspan along the lifespan from the cardiometabolic health perspective in both healthy individuals and individuals with well-controlled cardiometabolic diseases. The framework guides the shaping of the evidence base in the clinical approach for assessing and targeting intrinsic capacity and healthspan. This approach integrates well-established cardiometabolic guidelines with the innovative and rapidly developing field of healthspan medicine. Recommendations were developed through a literature review and structured Delphi consensus. To ensure methodological rigor, recommendations were developed using a grading framework adapted from AHA/ESC guidelines. This system applied standardized Classes of Recommendation (I, IIa-c, III) and added novel Class IIc to designate interventions with uncertain or minimal benefit, supported by limited or inconclusive evidence. Evidence levels ranged from multiple RCTs/meta-analyses (A) to single RCTs or non-RCT studies (B) to expert consensus (C). Such an approach is a crucial step toward building both evidence and credibility for clinical strategies aimed at preserving healthspan—specifically by preventing cardiometabolic pathological aging and the associated decline in intrinsic capacity. The healthspan-oriented care framework defines healthy aging from a cardiometabolic perspective, classifying individuals into “healthy aging without CMD” and “healthy aging with well-controlled CMD” based on clinical, laboratory, and functional criteria. The framework also evaluates emerging diagnostic tools and their role in risk stratification. While emerging approaches show considerable promise, their clinical translation requires further validation, standardization, and large-scale evidence. This Delphi-derived expert consensus outlines a comprehensive framework for the cardiometabolic healthspan-oriented model of care by integrating evidence-based clinical criteria, functional assessments, and emerging geroscience insights.