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Drugs

, Volume 39, Supplement 1, pp 1–8 | Cite as

Ageing and its Effects on the Cardiovascular System

  • M. Safar
Article

Summary

The study of the effect of ageing per se on cardiovascular structure and function is hindered by the occurrence of disease processes and lifestyle changes which are inextricably linked to the ageing process.

Both autopsy data and non-invasive techniques such as echocardiography have revealed a progressive hypertrophic increase in left ventricular wall thickness from the third decade of life onwards, although ageing does not lead to wall thicknesses exceeding the upper limit of normal. However, ventricular cavity dimensions are relatively unaffected by age. Left ventricular hypertrophy is an adaptive response to the increase in cardiac afterload caused by age-related arterial dilatation and loss of vascular compliance. In the large arteries, clinically significant intimal thickening and loss of distensibility occur by the age of 60 years, resulting in increased pulse pressure through elevation of systolic pressure. By comparison, the contribution of increased peripheral resistance to the development of hypertension in the elderly is relatively small. With increasing age, prolongation of isovolumic cardiac relaxation and loss of ventricular compliance combine to reduce the efficacy of early ventricular diastolic filling, but an increased atrial contribution to late ventricular filling offsets this, and no loss of left ventricular end-diastolic volume results. Resting cardiac output declines with ageing in healthy subjects. With increasing age, α-adrenoceptor-mediated effects on the vasculature appear to predominate, resulting in net vasoconstriction.

An age-related decline in cardiovascular performance under stress can be demonstrated by the measurement of maximal oxygen consumption during exercise. However, cardiac output is maintained in the disease-free elderly, since an increase in stroke volume compensates for the decline in maximal heart rate which accompanies ageing. It has been postulated that a diminished responsiveness to catecholamines underlies the age-dependent reduction in aerobic capacity.

Keywords

Cardiac Output Mitral Valve Stroke Volume Pulse Wave Velocity Peripheral Resistance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Avolio AP, Chen S, Wang R, Zhan C, Li M, et al. Effects of aging on changing arterial compliance and left ventricular load in a northern Chinese urban community. Circulation 68: 50–58, 1983PubMedCrossRefGoogle Scholar
  2. Brandfonbrener M, Landowne M, Shock NW. Changes in cardiac output with age. Circulation 12: 557–566, 1955PubMedCrossRefGoogle Scholar
  3. Conway J, Wheeler R, Hammerstedt R. Sympathetic nervous activity during exercise in relation to age. Cardiovascular Research 5: 577–581, 1971PubMedCrossRefGoogle Scholar
  4. Dehn MM, Bruce RA. Longitudinal variations in maximal oxygen uptake with age and activity. Journal of Applied Physiology 33: 805–807, 1972PubMedGoogle Scholar
  5. Fleg JL. Alterations in cardiovascular structure and function with advancing age. American Journal of Cardiology 57: 33C–44C, 1986PubMedCrossRefGoogle Scholar
  6. Gardin JM, Henry WL, Savage DD, Ware JH, Burn C, et al. Echocardiographic measurements in normal subjects: evaluation of an adult population without clinically apparent heart disease. Journal of Clinical Ultrasound 7: 439–447, 1979PubMedCrossRefGoogle Scholar
  7. Gerstenblith G, Frederickson J, Yin FCP, Fortuin NJ, Lakatta EG, et al. Echocardiographic assessment of a normal aging population. Circulation 56: 237–278, 1977CrossRefGoogle Scholar
  8. Gerstenblith G, Lakatta EG, Weisfeldt ML. Age changes in myocardial function and exercise response. Progress in Cardiovascular Diseases 19: 1–21, 1976PubMedCrossRefGoogle Scholar
  9. Goor D, Lillehei CW, Edwards JE. The “sigmoid septum”: variation in the contour of the left ventricular outlet. American Journal of Roentgenology 107: 366–376, 1969Google Scholar
  10. Julius S, Avery A, Whitlock LS, Conway J. Influence of age on the hemodynamic response to exercise. Circulation 36: 222–230, 1967PubMedCrossRefGoogle Scholar
  11. Kitzman DW, Scholz DG, Hagen PT, Ilstrup DM, Edwards WD. Age-related changes in normal human hearts during the first 10 decades of life. Part II (maturity): a quantitative anatomic study of 765 specimens from subjects 20 to 99 years old. Mayo Clinic Proceedings 63: 137–146, 1988PubMedGoogle Scholar
  12. Kuramoto K, Watsushita S, Mifrene J, Saka M, Mirakami M. Electrocardiographic and hemodynamic evaluation of isoproterenol test in elderly subjects. Japanese Circulation Journal 42: 955–960, 1978PubMedCrossRefGoogle Scholar
  13. Lakatta EG. Alterations in the cardiovascular system that occur in advanced age. Federation Proceedings 38: 163–167, 1979PubMedGoogle Scholar
  14. Lakatta EG. Age-related alterations in the cardiovascular response to adrenergic mediated stress. Federation Proceedings 39: 3173–3177, 1980PubMedGoogle Scholar
  15. Lakatta EG. Age-related changes in the heart. Geriatric Medicine Today 4: 90–97, 1985aGoogle Scholar
  16. Lakatta EG. Altered autonomic modulation of cardiovascular function with adult aging: perspectives from studies ranging from man to cells. In Stone ML, Weglicki WB (Eds) Pathobiology of cardiovascular injury, pp. 441–460, Martinus Nijhoff, Boston, 1985bCrossRefGoogle Scholar
  17. Lakatta EG. Do hypertension and aging have a similar effect on the myocardium? Circulation 75 (Suppl. I): 169–179, 1987Google Scholar
  18. Learoyd BM, Taylor MG. Alterations with age in the viscoelastic properties of human arterial walls. Circulation Research 18: 278–292, 1966PubMedCrossRefGoogle Scholar
  19. Levenson JA, Simon ACh, Fiessinger JN, Safar ME, London GM, et al. Systemic arterial compliance in patients with arteriosclerosis obliterans of the lower limbs: observations of the effect of intravenous propranolol. Arteriosclerosis 2: 266–271, 1982PubMedCrossRefGoogle Scholar
  20. Levy BI, Michel J-B, Salzmann J-L, Azizi M, Poitevin P, et al. Effects of chronic inhibition of converting enzyme on mechanical and structural properties of arteries in rat renovascular hypertension. Circulation Research 63(1): 227–239, 1988PubMedCrossRefGoogle Scholar
  21. Linzbach AJ, Akuamoa-Boateng E. Changes in the aging human heart. I. Heart weight in the aged. Klinische Wochenschrift 51: 156–163, 1973PubMedCrossRefGoogle Scholar
  22. Merillon JP, Motte G, Masquet C, Azancot I, Guiomard A, et al. Relationship between physical properties of the arterial system and left ventricular performance in the course of aging and arterial hypertension. European Heart Journal 3 (Suppl. A): 95–102, 1982PubMedGoogle Scholar
  23. Messerli FH. Cardiovascular adaptation in elderly hypertensive patients. Abstract. Journal of the American College of Cardiology 3: 518, 1984Google Scholar
  24. Messerli FH, Schmieder R. Left ventricular hypertrophy: a cardiovascular risk factor in essential hypertension. Drugs 31 (Suppl. 4): 192–201, 1986PubMedCrossRefGoogle Scholar
  25. Messerli FH, Sundgaard-Riise K, Ventura HO, Dunn FG, Oigman W, et al. Clinical and hemodynamic determinants of left ventricular dimensions. Archives of Internal Medicine 144: 447–481, 1984CrossRefGoogle Scholar
  26. Miller TR, Grossman SJ, Schectman KB, Biello DR, Ludbrook PA, et al. Left ventricular diastolic filling and its association with age. American Journal of Cardiology 58: 531–535, 1986PubMedCrossRefGoogle Scholar
  27. Miyatake K, Okamoto M, Kinoshita M, Owa M, Nakasone I, et al. Augmentation of atrial contribution to left ventricular inflow with aging as assessed by intracardiac Doppler flowmetry. American Journal of Cardiology 53: 586–589, 1984PubMedCrossRefGoogle Scholar
  28. Murgo JP, Westerhof N, Giolma JP, Altobelli SA. Effects of exercise on aortic input impedance and pressure wave forms in normal humans. Circulation Research 48: 334–343, 1981PubMedCrossRefGoogle Scholar
  29. Nichols WW, O’Rourke MF, Avolio AP, Yaginuma T, Murgo JP, et al. Effects of age on ventricular-vascular coupling. American Journal of Cardiology 55: 1179–1184, 1985PubMedCrossRefGoogle Scholar
  30. Nixon JV, Hallmark H, Page K, Raven PR, Mitchell JH. Ventricular performance in human hearts aged 61 to 73 years. American Journal of Cardiology 56: 932–937, 1985PubMedCrossRefGoogle Scholar
  31. O’Rourke MF. Arterial function in health and disease, pp. 53–66, 153–169, 196–252, Churchill Livingstone, Edinburgh-London-Melbourne-New York, 1982Google Scholar
  32. Rodeheffer RJ, Gerstenblith G, Becker LC, Fleg JL, Weisfeldt ML, et al. Exercise cardiac output is maintained with advancing age in healthy human subjects: cardiac dilatation and increased stroke volume compensate for a diminished heart rate. Circulation 69: 203–213, 1984PubMedCrossRefGoogle Scholar
  33. Safar ME, Simon ACh, Levenson JA. Structural changes of large arteries in sustained essential hypertension. Hypertension 6 (Suppl. III): 117–121, 1984Google Scholar
  34. Safar ME, London GM. Blood pressure in relation to physical aging processes in the arterial wall. Handbook of Hypertension 12: 70–84, 1989Google Scholar
  35. Sahasakul Y, Edwards WD, Naessens JM, Tajik J. Age-related changes in aortic and mitral valve thickness: implications for two-dimensional echocardiography based on an autopsy study of 200 normal human hearts. American Journal of Cardiology 62: 424–430, 1988PubMedCrossRefGoogle Scholar
  36. Schenk KE, Heinze G. Age-dependent changes of heart valves and heart size. Recent Advances in the Study of Cardiac Structure and Metabolism 10: 617–624, 1975Google Scholar
  37. Simon AC, Safar ME, Levenson JA, London GM, Levy BI, et al. An evaluation of large arteries compliance in man. American Journal of Physiology 237: H550–H554, 1979PubMedGoogle Scholar
  38. Sjogren AL. Left ventricular wall thickness in patients with circulatory overload of the left ventricle. Annals of Clinical Research 4: 310–318, 1972PubMedGoogle Scholar
  39. Spirito P, Maron BJ. Influence of aging on Doppler echocardiographic indices of left ventricular diastolic function. British Heart Journal 59: 672–679, 1988PubMedCrossRefGoogle Scholar
  40. Unverferth DV, Fetters JK, Unverferth BJ, Leier CV, Magorien RD, et al. Human myocardial histologic characteristics in congestive heart failure. Circulation 68: 1194–1200, 1983PubMedCrossRefGoogle Scholar
  41. Waller BF, Morgan R. The very elderly heart. Cardiovascular Clinics 18: 361–410, 1987Google Scholar
  42. Walsh RA. Cardiovascular effects of the aging process. American Journal of Medicine 82 (Suppl. 1B): 34–40, 1987PubMedCrossRefGoogle Scholar
  43. Yin FCP. The aging vasculature and its effect on the heart. In Weisfeldt ML (Ed) The aging heart: its function and response to stress pp. 137–213, Raven Press, New York, 1980Google Scholar
  44. Yin FCP, Spurgeon HA, Greene HL, Lakatta EG, Weisfeld ML. Age-associated decrease in heart rate response to isoproterenol in dogs. Mechanisms of Aging and Development 10: 17–25, 1979CrossRefGoogle Scholar

Copyright information

© ADIS Press Limited 1990

Authors and Affiliations

  • M. Safar
    • 1
  1. 1.Centre de DiagnosticHôpital BroussaisParisFrance

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