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This chapter addresses the following Geriatric Fellowship Curriculum Milestone: #9

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LEARNING OBJECTIVES

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Learning Objectives

  • Understand the effects of normal aging on cardiovascular structure and function.

  • Describe the effects of normal aging on anatomy and physiology of the heart and vasculature.

  • Understand the possible implications of the age-related changes in resting cardiovascular function.

  • Understand the role of age-related changes on lowering the threshold for clinical disease.

  • Describe the effect of age on the cardiovascular response during exercise.

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Key Clinical Points

  1. Normal aging is accompanied by substantial alterations in anatomy and physiology of the heart and vasculature.

  2. There are declines in most aspects of cardiovascular function, and these create significantly reduced reserve capacity, which becomes more apparent during exercise and stress.

  3. Many of the age-related changes may lower the threshold for clinical disease and, thus, predispose to a variety of cardiovascular disorders in older people.

  4. Awareness of the principles of aging biology, in general, will help clinicians tailor intelligent treatments to the older patient.

  5. Age-related declines in cardiovascular and exercise performance have been shown to be partially preventable and reversible with exercise training. Thus, maintaining regularly scheduled physical activity is an important strategy to mitigate the adverse effects of aging on cardiovascular function.

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PRINCIPLES OF AGING BIOLOGY PERTINENT TO THE CARDIOVASCULAR SYSTEM

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As the aging process begins after maturation, deteriorative, regenerative, and compensatory changes develop over time and result in diminished physiologic reserve capacity and an increased vulnerability to challenges, particular disease, and, as a result, a decrease in the ability to survive. Importantly, aging itself does not result in disease; however, it does lower the threshold for the development of disease and can intensify and accelerate the effects of disease once initiated. The increased vulnerability with age to external or internal challenges is one of the tenets of geriatrics and gerontology and is called homeostenosis.

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These concepts are particularly relevant to aging of the human cardiovascular system, especially older persons living in developed countries. When studying normal aging in these populations, it is important to consider screening for clinical and subclinical disease, particularly atherosclerosis, as well as to consider other cultural and environmental factors that are distinct from aging yet can mimic aging effects. These can manifest in human population studies as cohort and period effects, can be subtle or overt, and are easily confused with aging. It has been proposed that a true age-related change should be absent in young persons, increase with age, be universally present in very old persons, and not be related to any known, definable disease.

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In some early human aging studies, subjects with clinical and subclinical disease were not excluded, leading to an overestimation of the effects of aging on the cardiovascular system. Coronary atherosclerosis is highly prevalent in western societies and is one of the important disorders that can be occult and can significantly affect cardiac function. Systemic ...

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