Review of UK Biobank data suggests cardiovascular aging is a modular phenotype with distinct genetic determinants.

Chronological age is a potent determinant of clinical events, but it is conventionally treated as a linear function of time rather than a dynamic process shaped by genetics and tissue-specific senescence. Deep learning models derived from cardiovascular imaging offer an opportunity to quantify biological age across multiple domains and to examine the extent to which these measures capture shared or distinct vulnerabilities. Here, we applied deep learning to estimate biological age from electrocardiograms, cardiac MRI, carotid ultrasound, and retinal imaging, capturing electrical, structural, macrovascular, and microvascular domains in more than 100,000 UK Biobank participants. Genome-wide association and cross-trait heritability analyses showed that cardiovascular aging is not a singular process but a modular phenotype with distinct genetic determinants across modalities. Polygenic risk scores supported these distinct trajectories, showing that different biological age measures capture partly divergent biological processes with corresponding differences in clinical associations. Modality-specific genes also showcased distinct cell-type enrichment patterns. By deconvoluting aging into electrical, structural, macrovascular, and microvascular components, our results demonstrate that AI-derived age metrics capture distinct, disease-specific aging pathways. Ultimately, this modular framework positions deep learning-derived aging models not as holistic measures of health, but as domain-specific biomarkers of cardiovascular vulnerability.