Angina-Induced Protection Against Myocardial Infarction in Adult and Elderly Patients: A Loss of Preconditioning Mechanism in the Aging Heart?

Abstract

The presence of angina before acute myocardial infarction seems to confer protection against in-hospital outcomes in adults; this effect seemed to be less obvious in elderly patients. This study suggests that the protection afforded by angina in adult patients may involve the occurrence of ischemic preconditioning, which seems to be lost in senescent patients.

Angina pré-infarto na evolução intra-hospitalar de pacientes idosos com infarto agudo do miocárdio

“…Other studies assessing PIA in the elderly used different definitions and included patients with more advanced age, but achieved results similar to those of this subset of patients regarding the absence of the protective effect of PIA 10,11 . Our sample was predominantly male, in agreement with literature data, which report higher prevalence of AMI in this population 6,10,11,13 , as well as greater risk for developing AMI 14 .…”

“…This result was independent of thrombolytic therapy, even with the PIA group receiving more lytic therapy than the non-PIA group. After logistic regression analysis for potential confounders, the results remained unchanged 11 . Based on animal model studies showing that caloric restriction restored IPC, the same authors assessed the influence of body mass index (BMI) on the protective effect of PIA in the elderly and concluded that such protection was preserved only in the subset of elderly patients with the lowest BMI 23 .…”

“…The high mortality rate found in elderly patients who have AMI may be partly explained by the agerelated reduction in ischemic preconditioning. The following speculations might explain this reduction: decreased capacity to release mediators that activate the endogenous protective mechanism 28 and less probability of reperfusion 11 . According to Abete et al 29 , ischemic preconditioning may be preserved in elderly patients with high levels of physical activity 29 .…”

“…The same benefits were not demonstrated in patients older than 70 years of age 10 . Abete et al 11 also found favorable effects of preinfarction angina in adults; these effects, however, were less obvious in elderly patients 11 .…”

From the S.P. Botkin’s idea of “preexposure” to preconditioning phenomenon. Perspectives for use of phenomena of ischemic and pharmacological preconditioning

“…P. Abete et al [40] обнаружили, что у пациентов мо-лодого и среднего возраста, отмечавших наличие стенокардии до развития инфаркта миокарда, на-блюдался низкий процент развития кардиогенно-го шока, застойной сердечной недостаточности и внутригоспитальной смертности, что рассматри-валось авторами как проявление ИП. У пациентов 60-65 лет авторы наблюдали угнетение процессов ишемического прекондиционирования в миокарде.…”