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The ageing cardiovascular system

Published online by Cambridge University Press:  05 January 2011

Emily Bolton  and
Chakravarthi Rajkumar
Emily Bolton*
Affiliation:
Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
Chakravarthi Rajkumar
Affiliation:
Brighton and Sussex Medical School, Brighton, UK
*
Address for correspondence: Dr Emily Bolton, Conquest Hospital, The Ridge, St Leonards on Sea, East Sussex TN37 7RD. Email: [email protected]
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Summary

The increase in the ageing population has generated much interest and research into what constitutes normal ageing. By identifying normal ageing processes it is hoped it will be possible to distinguish risk factors for the development of abnormal or premature ageing.

This review discusses biological, structural and mechanical changes in the cardiovascular system with ageing that are thought to increase the risk of cardiovascular disease with ageing. Contributory factors are thought to be genetic and lifestyle related. Measurements of biological as opposed to chronological ageing such as vascular stiffness are explored as a possible useful predictor of cardiovascular morbidity and mortality, indicating its possible utilization as a non-invasive screening tool in older people.

The identification of those at risk of cardiovascular disease and modification of risk factors may minimize interactions of the ageing process and therefore reduce the incidence of cardiovascular disease within the UK population.

Keywords

cardiovascularageingrisk factorsstructural changesfunctional changesmolecular changeslifestyle effects
Type
Biological gerontology
Information
Reviews in Clinical Gerontology , Volume 21 , Issue 2 , May 2011 , pp. 99 - 109
Copyright
Copyright © Cambridge University Press 2011

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References

1Department of Health (2001). National service framework for older people. London: Department of Health.Google Scholar
2British Heart Foundation. Mortality statistics [online]. Available from: http://www.heartstats.org/datapage.asp?id=713 (accessed 17 May 2010).Google Scholar
3Kannel, W, Vasan, RS. Is age really a non-modifiable cardiovascular risk factor? Am J Cardiol 2009; 104: 1307–10.CrossRefGoogle ScholarPubMed
4Anon, . Thomas Sydenham (1624–1689). Quoted in Bulletin of the New York Acad Med 1928; 4: 993.Google Scholar
5Gerstenblith, G, Fredricksen, J, Yin, FC, Fortuin, NJ, Lakatta, EG, Weisfeld, ML. Echocardiographic assessment of a normal adult aging population. Circulation 1977; 56: 273–278.CrossRefGoogle ScholarPubMed
6Vimani, R, Avolio, AP, Mergener, WJ, Robinowitz, M, Herderick, EE, Cornhill, JF, Guo, SY, Liu, TH, Ou, DY, O'Rourke, M. Effect of aging on aortic morphology in populations with high and low prevalence of hypertension and atherosclerosis. Comparison between occidental and Chinese communities. Am J Pathol 1991; 139: 1119–29.Google Scholar
7Asai, K, Kudej, RK, Shen, YT, Yang, GP, Takagi, G, Kudej, AB, Geng, YJ, Sato, N, Nazareno, JB, Vatner, DE, Natividad, F, Bishop, SP, Vatner, SF. Peripheral vascular endothelial dysfunction and apoptosis in old monkeys. Arterioscler Thromb Vasc Biol 2000; 20: 1493–99.CrossRefGoogle ScholarPubMed
8Shi, Q, Aida, K, Vandenberg, JL, Wang, XL. Passage-dependent changes in baboon endothelial cells – relevance to in vitro aging. DNA Cell Biol 2004; 23: 502–9.CrossRefGoogle ScholarPubMed
9Csiszar, A, Wang, M, Lakatta, EG, Ungvari, Z. Inflammation and endothelial dysfunction during aging: role of NF-kappaB. J Appl Physiol 2008; 105: 1333–41.CrossRefGoogle ScholarPubMed
10Wagner, M, Hampel, B, Bernhard, D, Hala, M, Zwerschke, W, Jansen-Durr, P. Replicative senescence of human endothelial cells in vitro involves G1 arrest, polyploidization and senescence-associated apoptosis. Exp Gerontol 2001; 36: 1327–30.CrossRefGoogle ScholarPubMed
11Yeh, HI, Chang, HM, Lu, WW, Lee, YN, Ko, YS, Severs, NJ, Tsai, CH. Age-related alteration of gap junction distribution and connexin expression in rat aortic endothelium. J Histochem Cytochem 2000; 48: 1377–89.CrossRefGoogle ScholarPubMed
12Laogun, AA, Gosling, RG. In vivo arterial compliance in man. Clin Phys Physiol Meas 1982; 3: 201–12.CrossRefGoogle ScholarPubMed
13Safar, ME, Pannier, B, Laurent, S, London, GM. Calcium-entry blockers and arterial compliance in hypertension. J Cardiovasc Pharmacol 1989; 14 (suppl 10): S1–6, discussion S59–62.CrossRefGoogle ScholarPubMed
14Hodes, RJ, Lakatta, EG, McNeil, CT. Another modifiable risk factor for cardiovascular disease? Some evidence points to arterial stiffness. J Am Geriatr Soc 1995; 43: 581–82.CrossRefGoogle ScholarPubMed
15Franklin, SS, Gustin, W 4th, Wong, ND, Larson, MG, Weber, MA, Kannel, WB, Levy, D. Hemodynamic patterns of age-related changes in blood pressure. The Framingham heart study. Circulation 1997; 96: 308–15.CrossRefGoogle ScholarPubMed
16Wang, KL, Cheng, HM, Sung, SH, Chuang, SY, Li, CH, Spurgeon, HA, Tring, CT, Najjar, SS, Lakatta, EG, Yin, FC, Chou, P, Chen, CH. Wave reflection and arterial stiffness in the prediction of 15-year all-cause and cardiovascular mortalities: a community based study. Hypertension 2010; 55: 799–805.CrossRefGoogle ScholarPubMed
17Laurent, S, Boutouyrie, P, Asmar, R, Gautier, I, Laloux, B, Guize, L, Ducimetiere, P, Benetos, A. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001; 37: 1236–41.CrossRefGoogle ScholarPubMed
18London, GM, Blacher, J, Pannier, B, Guérin, AP, Marchais, SJ, Safar, ME. Arterial wave reflections and survival in end-stage renal failure. Hypertension 2001; 38: 434–38.CrossRefGoogle ScholarPubMed
19National Collaborating Centre for Chronic Conditions. Hypertension: management in adults in primary care: pharmacological update. London: Royal College of Physicians, 2006.Google Scholar
20Pan, HY, Hoffman, BB, Pershe, RA, Blaschke, TF. Decline in beta adrenergic receptor-mediated vascular relaxation with aging in a man. J Pharmacol Exp Ther 1986; 239: 802–7.Google Scholar
21Bouthier, JD, De Luca, N, Safar, ME, Simon, AC. Cardiac hypertrophy and arterial distensibility in essential hypertension. Am Heart J 1985; 109: 1345–52.CrossRefGoogle ScholarPubMed
22Kingwell, BA, Waddell, TK, Medley, TL, Cameron, JD, Dart, AM. Large artery stiffness predicts ischemic threshold in patients with coronary artery disease. J Am Coll Cardiol 2002; 40: 773–79.CrossRefGoogle ScholarPubMed
23Fleg, JL, O'Connor, FC, Gerstenblith, G, Becker, LC, Clulow, J, Schulman, SP, Lakatta, EG. Impact of age on the cardiovascular response to dynamic upright exercise in healthy men and women. J Appl Physiol 1995; 78: 890–900.CrossRefGoogle ScholarPubMed
24Levy, D, Anderson, KM, Savage, DD, Kannel, WB, Christiansen, JC, Castelli, WP. Echocardiographically detected left ventricular hypertrophy: prevalence and risk factors. The Framingham heart study. Ann Intern Med 1988; 108: 7–13.CrossRefGoogle ScholarPubMed
25Lakatta, EG. Cardiovascular aging in health. Clinics Geriatr Med 2000; 16: 419–44.CrossRefGoogle ScholarPubMed
26Olivetti, G, Giordano, G, Corradi, D, Melissari, M, Lagrasta, C, Gambert, SR, Anversa, P. Gender differences and aging: effects on the human heart. J Am Coll Cardiol 1995; 26: 1068–79.CrossRefGoogle ScholarPubMed
27Shirani, J, Yousefi, J, Roberts, WC. Major cardiac findings at necropsy in 366 American octogenarians. Am J Cardiol 1995; 75: 151–56.CrossRefGoogle ScholarPubMed
28Cheitlin, MD, Zipes, DP. Cardiovascular disease in the elderly. In Braunwald, E, Zipes, DP, Libby, P (eds). Heart Disease. 6th edn.Philidelphia, PA: WB Saunders; 2001.Google Scholar
29Rodeheffer, RJ, Gerstenblith, G, Beard, E, Fleg, JL, Becker, LC, Weisfeldt, ML, Lakatta, EG. Postural changes in cardiac volumes in men in relation to adult age. Exp Gerontol 1986; 21: 367–78.CrossRefGoogle ScholarPubMed
30Lakatta, EG. Cardiovascular regulatory mechanisms in advance age. Physiol 1993; 73: 413–67.Google Scholar
31Schulman, S, Lakatta, EG, Fleg, JL, Lakatta, L, Becker, LC, Gerstenblith, G. Age-related decline in left ventricular filling at rest and exercise. Am J Physiol 1992; 263: H1932–38.Google ScholarPubMed
32Swinne, CJ, Shapiro, EP, Lima, SD, Fleg, JL. Age-associated changes in left ventricular diastolic performance during isometric exercise in normal subjects. Am J Cardiol 1992; 69: 823–26.CrossRefGoogle ScholarPubMed
33Wei, JY, Spurgeon, HA, Lakatta, EG. Excitation–contraction in rat myocardium: alterations with adult aging. Am J Physiol 1984; 246: H784–91.Google ScholarPubMed
34Benjamen, EJ, Levy, D, Anderson, KM, Wolf, PA, Plehn, JF, Evans, JC, Comai, K, Fuller, DL, Suttton, MS. Determinants of Doppler indexes in left ventricular function in normal subjects (the Framingham heart study). Am J Cardiol 1992; 70: 508–15.CrossRefGoogle Scholar
35British Heart Foundation. Mortality from heart failure statistics [online]. Available at: http://www.heartstats.org/datapage.asp?id=752 (accessed 15 May 2010).Google Scholar
36Anderson, B, Waagstein, F. Spectrum and outcome of congestive heart failure in a hospitalized population. Am Heart J 1993; 126: 632–40.CrossRefGoogle Scholar
37Wang, M, Zhang, J, Spinetti, G, Jiang, LQ, Monticone, R, Zhao, D, Cheng, L, Krawczyk, M, Talan, M, Pintus, G, Lakatta, EG. Angiotensin II activates matrix metalloproteinase type II and mimics age-associated carotid arterial remodeling in young rats. Am J Pathol 2005; 167: 1429–42.CrossRefGoogle ScholarPubMed
38Wang, M, Takagi, G, Asai, K, Resuello, RG, Natividad, FF, Vatner, DE, Vatner, SF, Lakatta, EG. Aging increases aortic MMP-2 activity and angiotensin II in non-human primates. Hypertension 2003; 41: 1308–16.CrossRefGoogle Scholar
39Wang, M, Zhang, J, Jiang, LQ, Spinetti, G, Pintus, G, Monticone, R, Kolodgie, FD, Virmani, R, Lakatta, EG. Proinflammatory profile within the grossly normal aged human aortic wall. Hypertension 2007; 50: 219–27.CrossRefGoogle ScholarPubMed
40Jiang, L, Wang, M, Zhang, J, Monticone, RE, Telljohann, R, Spinetti, G, Pintus, G, Lakatta, EG. Increased aortic alpain-1 activity medicates age-associated angiotensin II signalling of vascular smooth muscle cells. PLoS One 2008; 3: e2231.CrossRefGoogle Scholar
41Bode-Boger, SM, Muke, J, Surdacki, A, Brabant, G, Böger, RH, Frölich, JC. Oral L-arginine improves endothelial function in healthy individuals older than 70 years. Vasc Med 2003; 8: 77–81.CrossRefGoogle ScholarPubMed
42McVeigh, GE, Allen, PB, Morgan, DR, Hanratty, CG, Silke, B. Nitric oxide modulation of blood vessel tone identified by arterial wave form analysis. Clin Sci 2001; 100: 387–93.CrossRefGoogle Scholar
43Chan, SR, Blackburn, EH. Telomeres and telomerase. Phil Trans R Soc Lond B Biol Sci 2004; 359: 109–21.CrossRefGoogle ScholarPubMed
44Xu, D, Neville, R, Finkel, T. Homcysteine accelerates endothelial cell senescence. FEBS Lett 2000; 470: 20–24.CrossRefGoogle Scholar
45Allsop, RC, Harley, CB. Evidence for a critical telomere length in senescent human fibroblasts. Exp Cell Res 1995; 219: 130–36.CrossRefGoogle Scholar
46Vaziri, H, Dragowska, W, Allsop, RC, Thomas, TE, Harley, CB, Lansdorp, PM. Evidence for a mitotic clock in human haematopoietic stem cells: loss of telomeric DNA with age. Proc Natl Acad Sci USA 1994; 91: 9857–60.CrossRefGoogle ScholarPubMed
47Cawthon, RM, Smith, KR, O'Brien, E, Sivatchenko, A, Kerber, RA. Association between telomere length in blood and mortality in people aged 60 years or older. Lancet 2003; 361: 393–95.CrossRefGoogle ScholarPubMed
48Benetos, A, Gardner, KP, Zureik, M, Labat, C, Xiaobin, L, Adamopoulos, C, Temmar, M, Bean, KE, Thomas, F, Aviv, A. Short telomeres are associated with increased carotid atherosclerosis in hypertensive subjects. Hypertension 2004; 43: 182–85.CrossRefGoogle ScholarPubMed
49Collerton, J, Martin Ruiz, C, Kenny, A, Barrass, K, von Zglinicki, T, Kirkwood, T, Keavney, B; Newcastle 85+ Core Study Team. Telomere length is associated with left ventricular function in the oldest old: the Newcastle 85+ study. Eur Heart J 2007; 28: 172–76.CrossRefGoogle ScholarPubMed
50Jeancuis, E, Krolewski, A, Skurnucj, J, Kimura, M, Aviv, H, Warram, JH, Aviv, A. Shortened telomere length in white bloods cells of patients with IDDM. Diabetes 1998; 47: 482–86.Google Scholar
51Sampson, MJ, Winterbourne, MS, Hughes, JC, Dozio, N, Hughes, DA. Monocyte telomere shortening and oxidative DNA damage in type 2 diabetes. Diabetes Care 2006; 29: 283–89.CrossRefGoogle ScholarPubMed
52Demissie, S, Levy, D, Benjamin, EJ, Cupples, LA, Gardner, JP, Herbert, A, Kimura, M, Larson, MG, Meigs, JB, Keaney, JF, Aviv, A. Insulin resistance, oxidative stress, hypertension and leukocyte telomere length in men from the Framingham Heart study. Aging Cell 2006; 5: 325–30.CrossRefGoogle ScholarPubMed
53Benetos, A, Okuida, K, Lajemi, M, Kimura, M, Thomas, F, Skurnick, J, Labat, C, Bean, K, Aviv, A. Telomere length as an indicator of biological aging: the gender effect and relation with pulse pressure and pulse wave velocity. Hypertension 2001; 37: 381–85.CrossRefGoogle ScholarPubMed
54Wu, FC, von Eckardstein, A. Androgens and coronary artery disease. Endocr Rev 2003; 24: 183–217.CrossRefGoogle ScholarPubMed
55Rossouw, JE, Anderson, GL, Prentice, RL, LaCroix, AZ, Kooperberg, C, Stefanick, ML, Jackson, RD, Beresford, SA, Howard, BV, Johnson, KC, Kotchen, JM, Ockene, J; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's health initiative randomized controlled trial. JAMA 2002; 288: 321–33.Google ScholarPubMed
56Sullivan, ML, Martinez, CM, Gennis, P, Gallagher, EJ. The cardiac toxicity of anabolic steroids. Prog Cardiovasc Dis 1998; 41: 1–15.CrossRefGoogle ScholarPubMed
57Rajkumar, C, Kingwell, BA, Cameron, JD, Cameron, JD, Waddell, T, Mehra, R, Christophidis, N, Komesaroff, PA, McGrath, B, Jennings, GL, Sudhir, K, Dart, AM. Hormonal therapy increases arterial compliance in postmenopausal women. J Am Coll Cardiol 1997; 30: 350–56.CrossRefGoogle ScholarPubMed
58Waddell, TK, Rajkumar, C, Cameron, JD, Jennings, GL, Dart, AM, Kingwell, BA. Withdrawal of hormonal therapy for 4 weeks decreases arterial compliance in post menopausal women. J Hypertens 1999; 17: 413–18.CrossRefGoogle Scholar
59Dockery, F, Bulpitt, CJ, Donaldson, M, Fernandez, S, Rajkumar, C. The relationship between androgens and arterial stiffness in older men. J Am Geriatr Soc 2003; 51: 1627–32.CrossRefGoogle ScholarPubMed
60Getov, SV, Lee, R, Dockery, F, Rajkumar, C. Androgens, ageing and vascular function. Age Ageing 2008; 37: 361–63.CrossRefGoogle ScholarPubMed
61Chaturvedi, N. Ethnic differences in cardiovascular disease. Heart 2003; 89: 681–86.CrossRefGoogle ScholarPubMed
62Cameron, JD, Bulpitt, CJ, Pinto, ES, Rajkumar, C. The aging of elastic and muscular arteries: a comparison of diabetic and non-diabetic subjects. Diabetes Care 2003; 26: 2133–38.CrossRefGoogle Scholar
63Chaturvedi, M, Bulpitt, CJ, Leggetter, S, Schiff, R, Nihoyannopoulos, P, Strain, WD, Shore, AC, Rajkumar, C. Ethnic differences in vascular stiffness and relations to hypertensive target organ damage. J Hypertens 2004; 22: 1731–37.CrossRefGoogle ScholarPubMed
64Kalra, L, Rambaran, C, Chowienczyk, P, Goss, D, Hambleton, I, Ritter, J, Shah, A, Wilks, R, Forrester, T. Ethnic differences in arterial responses and inflammatory markers in Afro-Caribbean and Caucasian subjects. Arterioscler Thromb Vasc Biol 2005; 25: 2362–67.CrossRefGoogle ScholarPubMed
65Kvaavik, E, Batty, GD, Ursin, G, Huxley, R, Gale, CR. Influence of individual and combined health behaviours on total and cause-specific mortality in men and women: the United Kingdom health and lifestyle survey. Arch Intern Med 2010; 170: 711–18.CrossRefGoogle ScholarPubMed
66Gates, PE, Tanaka, H, Hiatt, W, Seals, DR. Dietary sodium restriction rapidly improves large elastic artery compliance in older adults with systolic hypertension. Hypertension 2004; 44: 35–41.CrossRefGoogle ScholarPubMed
67Chin, JP, Gust, AP, Nestel, PJ, Dart, AM. Marine oils dose-dependently inhibit vasoconstriction of forearm resistance vessels in humans. Hypertension 1993; 21: 22–28.CrossRefGoogle ScholarPubMed
68Zhang, X, Shu, XO, Gao, YT, Yang, G, Li, Q, Li, H, Jin, F, Zheng, W. Soy food consumption is associated with lower risk of coronary heart disease in Chinese women. J Nutr 2003; 133: 2874–78.CrossRefGoogle ScholarPubMed
69Van der Schouw, YT, Pijpe, A, Lebrun, CE, Bots, ML, Peeters, PH, van Staveren, WA, Lamberts, SW, Grobbee, DE. Higher usual dietary intake of phytoestrogens is associated with lower aortic stiffness in postmenopausal women. Arterioscler Thromb Vasc Biol 2002; 22: 1316–22.CrossRefGoogle ScholarPubMed
70Teede, HJ, McGrath, BP, DeSilva, L, Cehun, M, Fassoulakis, A, Nestel, PJ. Isoflavones reduce arterial stiffness: a placebo-controlled study in men and post-menopausal women. Arterioscler Throb Vasc Biol 2003; 23: 1066–71.CrossRefGoogle Scholar
71Sutton-Tyrell, K, Neman, A, Simonsick, EM, Havlik, R, Pahor, M, Lakatta, E, Spurgeon, H, Vaitkevicius, Pl. Aortic stiffness is associated with visceral adiposity in older adults enrolled in the study of health, aging and body composition. Hypertension 2001; 38: 429–33.CrossRefGoogle Scholar
72Kool, MJ, Hoeks, AP, Struijker Boudier, HA, Reneman, RS, Van Bortel, LM. Short and long term effects of smoking on arterial wall properties in habitual smokers. J Am Coll Cardiol 1993; 22: 1881–86.CrossRefGoogle Scholar
73Mahmud, A, Feely, J. Effect of smoking on arterial stiffness and pulse pressure amplification. Hypertension 2003; 41: 183–87.CrossRefGoogle ScholarPubMed
74Fantin, F, Rajkumar, C. The assessment of the aging artery. Rev Clin Gerontol 2005; 15: 71–82.CrossRefGoogle Scholar
75Sierksma, A, Muller, M, van de Schouw, YT, Grobbee, DE, Hendricks, HF, Bots, ML. Alcohol consumption and arterial stiffness in men. J Hypertens 2004; 22: 357–62.CrossRefGoogle ScholarPubMed
76Rosito, GA, Fuchs, FD, Duncan, BB. Dose-dependent biphasic effect of ethanol on 24-h blood pressure in normotensive subjects. Am J Hypertens 1999; 12: 236–40.CrossRefGoogle ScholarPubMed
77Mahmud, A, Feely, J. Divergent effect of acute and chronic alcohol on arterial stiffness. Am J Hypertens 2002; 15: 240–43.CrossRefGoogle ScholarPubMed
78Fleg, JL, Lakatta, EG. Role of muscle loss in the age-associated reduction in VO2, max. J Appl Physiol 1988; 65: 1147–51.CrossRefGoogle ScholarPubMed
79Vaitikevicius, PV, Fleg, JL, Engel, JH, O'Connor, FC, Wright, JG, Lakatta, LE, Yin, FC, Lakatta, EG. Effects of age and aerobic capacity on arterial stiffness in healthy adults. Circulation 1993; 88: 1456–62.CrossRefGoogle Scholar
80Tanaka, H, DeSouza, CA, Seals, DR. Absence of age-related increase in central arterial stiffness in physically active women 18–95 years. Arteroscler Thromb Vasc Biol 1998; 18: 127–32.CrossRefGoogle Scholar
81Hunt, BE, Farquhar, WB, Taylor, JA. Does reduced vascular stiffening fully explain preserved cardiovagal baroreflex function in older, physically active men? Circulation 2001; 103: 2424–27.CrossRefGoogle ScholarPubMed
82Rywik, TM, Blackman, R, Yataco, AR, Vaitkevicius, PV, Zink, RC, Cottrell, EH, Wright, JG, Katzel, LI, Fleg, JL. Enhanced endothelial vasocreactivity in endurance-trained older men. J Appl Physiol 1999; 87: 2136–42.CrossRefGoogle ScholarPubMed
83Cameron, JD, Rajkumar, C, Kingwell, BA, Jennings, GL, Dart, AM. Higher systemic arterial compliance is associated with greater exercise time and lower blood pressure in a young older population. J Am Geriatr Soc 1999; 47: 653–56.CrossRefGoogle Scholar