<p>With the aging of the population, age-related diseases, especially those associated with vascular aging, have become a leading cause of death worldwide, severely affecting quality of life and placing a heavy burden on healthcare systems. Recent studies have highlighted the crucial role of perivascular adipose tissue (PVAT) in vascular aging and age-related diseases. However, the potential of PVAT assessment as an early biomarker for disease prevention and prognostic evaluation remains to be fully explored. This review not only discusses the emerging relevance of PVAT in clinical research, particularly in the evaluation of vascular health, disease progression, and treatment response, but also explores how modern technological methods can be used to assess PVAT, revealing its changes during the vascular aging process and its clinical translational potential. More importantly, while acknowledging ongoing challenges regarding standardization and the need for large-scale prospective validation, this review emphasizes the investigational value of PVAT assessment and highlights its emerging potential in disease prevention, early diagnosis, and treatment monitoring. By systematically evaluating PVAT function and changes, we can not only better understand its role in vascular aging and related diseases, but also uncover the close connection between PVAT changes and the underlying mechanisms of vascular aging. This provides a more targeted and practical theoretical basis for future clinical applications and interventions, paving the way for novel intervention strategies in the prevention and treatment of vascular aging and related diseases.</p> Graphic abstract <p></p>