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Changes in the vascular system associated with aging contribute to conditions such as hypertension and atherosclerosis. In this study, we explored the prevalence and survival effects of vascular aging phenotypes in a Russian population, a group with a very high cardiovascular risk according to the SCORE2 scale. A cohort of 618 participants from three metro areas underwent carotid-femoral pulse wave velocity (cfPWV) assessment between 2012 and 2018, with biannual follow-ups to record cardiovascular events and mortality. We compared our data with findings from previously published European cohorts to evaluate methods for classifying vascular aging phenotypes. Our findings indicate that definitions designed for low- and medium-risk populations are of limited use in high-risk groups. Moreover, the association between elevated cfPWV and increased overall mortality suggests a potential selection pressure on vascular aging phenotypes. These insights advance the development of predictive biomarkers for cardiovascular risk in populations with high rates of cardiovascular disease.