Since the beginning of the 20th century human life expectancy has doubled to more than 80 years, and growth and aging of the world population now represent major challenges for healthcare providers, political decision makers, and societies. Cellular senescence is associated with a general, pro-inflammatory state, which represents the common denominator between aging and chronic diseases and their progression. Approaches to interfere with these changes and to allow healthy aging involve modulation of the cellular activity of modifiable molecular mediators (MMMs), such as signaling molecules and growth factors. ET-1 - the biologically predominant member of the endothelin peptide family - is an endothelial cell-derived peptide with a wide variety of developmental and physiological functions, which include embryogenesis, nociception, and natriuresis. In addition, ET-1 is a cytokine-like, multifunctional peptide with pro-inflammatory, mitogenic, and vasoconstrictor properties. If produced in excess amounts ET-1 promotes disease - mainly via activation of its ETA receptor. Because of its multiple disease-promoting functions ET-1 represents an ideal _target MMM. Preclinical studies _targeting either activity or production of ET-1 - utilizing ERAs, ARBs, or ACEIs, respectively - have demonstrated that partial regression of aging-associated changes in vasculature and kidney is possible. In this article I will review the molecular regulation of ET-1 and its role in the physiology of vascular homeostasis, aging, and cellular senescence. The clinical implications of activators of ET-1 overproduction, modalities for delaying or reversing aging-related cellular changes, as well as interventions to promote healthy aging and early disease prevention - particularly physical activity - are discussed.