Clonal hematopoiesis, aging, and cardiovascular diseases

•Clonal hematopoiesis (CH) is associated with atherosclerosis, heart failure, and stroke.•Common risk factors prompt CH, cancer, and cardiovascular diseases (CVD).•Inflammation promotes CVD and affects tissue regeneration.•The outcome of heart failure and aortic valve stenosis patients with DNMT3A/TET2-CH mutations is poor.•A vicious circuit is induced by CH-mutated myeloid cells on CVDs and hematopoiesis. Cardiovascular diseases (CVDs) remain the leading cause of death worldwide. Many studies have provided evidence that both genetic and environmental factors induce atherosclerosis, leading thus to cardiovascular complications. Atherosclerosis is an inflammatory disease, and aging is strongly associated with the development of atherosclerosis. Recent experimental evidence suggests that clonal hematopoiesis (CH) is an emerging cardiovascular risk factor that contributes to the development of atherosclerosis and cardiac dysfunction and exacerbates cardiovascular diseases. CH is caused by somatic mutations in recurrent genes in hematopoietic stem cells, leading to the clonal expansion of mutated blood cell clones. Many of the mutated genes are known in the context of myeloid neoplasms. However, only some individuals carrying CH mutations develop hematologic abnormalities. CH is clearly age dependent and is not rare: at least 10%–20% of people >70 years old carry CH. The newly discovered association between myeloid leukemia-driver mutations and the progression of CVDs has raised medical interest. In this review, we summarize the current view on the contribution of CH in different cardiovascular diseases, CVD risk assessment, patient stratification, and the development of novel therapeutic strategies.