Gender and sex are key regulators of cardiovascular system physiology, pathology, and disease progression. The process of atherosclerosis, together with the increasing loss of arterial flexibility with age, is a primary factor determining the development of overt cardiovascular, renal, and cerebrovascular illness. While variations in the epidemiology and pathophysiology of vascular ageing between men and women are progressively being described, sex-disaggregated data for prospective research are still uncommon. It is critical to have a better understanding of sex variations in physiological ageing as well as disease-related alterations in vascular ageing trajectories in order to avoid misdiagnosis and maltreatment. This review identifies critical ideas and information gaps in vascular ageing caused by gonadal function, vascular physiology, pathophysiology, psychosocial variables, pregnancy, and prognostic implications. Gender roles influence the efficiency of any cardiovascular preventive plan as well as the adoption of non-invasive and invasive tests and therapies