Aging-Associated Cardiovascular Changes and Their Relationship to Heart Failure

Abstract

Synopsis Aging represents a convergence of declining cardioprotective systems and increasing disease processes that is fertile ground for the development of heart failure. With 50% of all heart failure diagnoses and 90% of all heart failure deaths occurring in the segment of the population over age 70, heart failure is largely a disease of the elderly. This review discusses the microscopic and macroscopic changes in cardiovascular structure, function, protective systems, and disease associated with aging. In addition to outlining important clinical considerations and conditions in older persons, the link between normal aging and the elevated risk for development of stage B heart failure is explained and potential therapeutic pathways highlighted.

Cardiac aging and heart disease in humans

“…The bulk of ventricular filling shifts to later in diastole and there is significant atrial enlargement. Therefore, the atrium assumes a greater portion of the total end diastolic volume and the E/A ratio decreases (Strait and Lakatta 2012). Age-related diastolic dysfunction is linked to the epidemic of HFpEF (Desai and Fang 2008), a disease that was previously named diastolic heart failure.…”

“…In addition, tissue remodeling affects the functioning of the atrioventricular node, the bundle of His and the bundle branches. The resulting changes in depolarization and repolarization of the atria and the ventricles are reflected by age-associated changes in ECG measurements: An increase in P-wave duration, P-R interval and Q-T interval, a decrease in QRS voltage and T-wave voltage and a leftward shift of the QRS axis (Strait and Lakatta 2012). In addition, the prevalence of both atrial and ventricular ectopic beats increases.…”

“…LV hypertrophy is mostly seen as a compensatory response after the loss of cardiomyocytes with aging (Olivetti et al 1991). There have been conflicting data concerning the evolution of LV mass with age, but recent analyses tend towards no effect on mass (Akasheva et al 2015) or a sex-specific decrease in men only (Strait and Lakatta 2012). LV dimension decreases with age, reflected by an increase in the mass/volume ratio and a decrease in LV end-diastolic volume (Cheng et al 2009).…”

Mediating Age-related Cognitive Decline Through Lifestyle Activities: A Brief Review Of The Effects Of Physical Exercise And Sports-playing On Older Adult Cognition

“…Physical exercise is beneficial for older adults in terms of reducing the risk of a plethora of health conditions, including heart disease [45], diabetes mellitus [46], obesity [47], and osteoporosis and arthritis [48], all of which are diseases that increase in prevalence in older adulthood [49][50][51][52]. More generally, physical exercise is effective in increasing cardiovascular fitness, muscle strength, bone mineral density, alleviating depression and anxiety, and improving self-esteem in older adults [53].…”

Sirtuins, aging, and cardiovascular risks

“…With age, the apoptotic and necrotic processes lead to a decrease of cardiomyocytes, an increase of oxidative stress promoting an inflammatory and fibrotic environment, an impaired neovascularization capacity due to a reduction of pro-angiogenic functions, and a decreased capacity of progenitor cells of the bone marrow-derived cells to contribute to functional repair (Bronze-da-Rocha 2014; Dimmeler and Leri 2008;Strait and Lakatta 2012).…”