Physiologic Changes in Cardiac Function with Aging

Chapter

Abstract

Age-related changes in the cardiovascular system, overt and occult cardiovascular disease, and decreased physical activity affect cardiovascular function in older persons. With aging, there is a loss of myocytes in both the left and right ventricles with a progressive increase in myocyte cell volume per nucleus in both ventricles [1]. There is also a progressive decrease in the number of pacemaker cells in the sinus node, with only 10% of the number of cells present at age 20 remaining at age 75 [2].

Keywords

Placebo Radionuclide Cardiomyopathy Catecholamine Digoxin 

References

  1. 1.
    Olivetti G, Melissari M, Capasso JM et al (1991) Cardiomyopathy of the aging human heart: myocyte loss and reactive cellular hypertrophy. Circ Res 68:1560–1568PubMedCrossRefGoogle Scholar
  2. 2.
    Davies MJ (1988) The pathological basis of arrhythmias. Geriatr Cardiovasc Med 1:181–183Google Scholar
  3. 3.
    Gonzalez A, Rota M, Nurzynska D et al (2008) Activation of cardiac progenitor cells reverses the failing heart senescent phenotype and prolongs lifespan. Circ Res 102:597–606PubMedCrossRefGoogle Scholar
  4. 4.
    Anversa P (2005) Aging and longevity. The IGF-1 enigma. Circ Res 97:411–414PubMedCrossRefGoogle Scholar
  5. 5.
    Anversa P, Rota M, Urbanek K et al (2005) Myocardial aging – a stem cell problem. Basic Res Cardiol 100:482–493PubMedCrossRefGoogle Scholar
  6. 6.
    Gerstenblith G, Fredericksen J, Yin FCP et al (1977) Echocardio-graphic assessment of a normal adult aging population. Circulation 56:273–278PubMedCrossRefGoogle Scholar
  7. 7.
    Safar M (1990) Aging and its effects on the cardiovascular system. Drugs 39(suppl 1):1–8PubMedCrossRefGoogle Scholar
  8. 8.
    Yin FCP (1980) The aging vasculature and its effects on the heart. In: Weisfeldt ML (ed) The aging heart: its function and response to stress. Raven, New York, pp 137–214Google Scholar
  9. 9.
    Avolio AP, Fa-Quan D, Wei-Qiang L et al (1985) Effects of aging on arterial distensibility in populations with high and low prevalence of hypertension: comparison between urban and rural communities in China. Circulation 71:202–210PubMedCrossRefGoogle Scholar
  10. 10.
    Boutouyrie P, Laurent S, Benetos A et al (1992) Opposing effects of ageing on distal and proximal large arteries in hypertensives. J Hypertens 10:587–591CrossRefGoogle Scholar
  11. 11.
    Nichols WW, O’Rourke MF, Avolio AP et al (1985) Effects of age on ventricular-vascular coupling. Am J Cardiol 55:1179–1184PubMedCrossRefGoogle Scholar
  12. 12.
    Rodeheffer RJ, Gerstenblith G, Becker LC et al (1984) 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 69:203–213PubMedCrossRefGoogle Scholar
  13. 13.
    Brandfonbrener M, Landowne M, Shock NW (1955) Changes in cardiac output with age. Circulation 12:557–566PubMedCrossRefGoogle Scholar
  14. 14.
    Pan HY, Hoffman BB, Pershe RA et al (1986) Decline in beta-adrenergic receptor-mediated vascular relaxation with aging in man. J Pharmacol Exp Ther 239:802–807PubMedGoogle Scholar
  15. 15.
    Buhler F, Kowski W, Van Brumeler P (1980) Plasma catecholamines and cardiac, renal and peripheral vascular adrenoceptor mediated response in different age groups in normal and hypertensive subjects. Clin Exp Hypertens 2:409–426PubMedCrossRefGoogle Scholar
  16. 16.
    Landahl S, Bengtsson C, Sigurdsson JA et al (1986) Age-related change in blood pressure. Hypertension 8:1044–1049PubMedCrossRefGoogle Scholar
  17. 17.
    Avolio AP, Clyde KM, Beard TC et al (1986) Improved arterial distensibility in normotensive subjects on a low salt diet. Arteriosclerosis 6:166–169PubMedCrossRefGoogle Scholar
  18. 18.
    Vaitkevicius PV, Fleg JL, Engel JH et al (1993) Effects of age and aerobic capacity on arterial stiffness in healthy adults. Circulation 88:1456–1462PubMedCrossRefGoogle Scholar
  19. 19.
    Mitchell GF, Guo C-Y, Benjamin EJ et al (2007) Cross-sectional correlates of increased aortic stiffness in the community. The Framingham Heart Study. Circulation 115:2628–2636PubMedCrossRefGoogle Scholar
  20. 20.
    Lima JAC, Gerstenblith G, Weiss JL et al (1988) Systolic blood pressure, not age mediates the age-related increase in left ventricular wall thickness within a normotensive population (abstract). J Am Coll Cardiol 11:81AGoogle Scholar
  21. 21.
    Levy D, Anderson KM, Savage DD et al (1988) Echocardiographically detected left ventricular hypertrophy: prevalence and risk factors: the Framingham heart study. Ann Intern Med 108:7–13PubMedGoogle Scholar
  22. 22.
    Aronow WS, Ahn C, Kronzon I (1997) Prevalence of echocardiographic findings in 554 men and in 1243 women aged >60 years in a long-term health care facility. Am J Cardiol 79:379–380PubMedCrossRefGoogle Scholar
  23. 23.
    Aronow WS, Ahn C (1996) Risk factors for new coronary events in a large cohort of very elderly patients with and without coronary artery disease. Am J Cardiol 77:864–866PubMedCrossRefGoogle Scholar
  24. 24.
    Aronow WS, Kronzon I (1991) Prevalence of coronary risk factors in elderly Blacks and Whites. J Am Geriatr Soc 39:567–570PubMedGoogle Scholar
  25. 25.
    Aronow WS, Koenigsberg M, Schwartz KS (1988) Usefulness of echocardiographic left ventricular hypertrophy in predicting new coronary events and atherothrombotic brain infarction in patients over 62 years of age. Am J Cardiol 61:1130–1132PubMedCrossRefGoogle Scholar
  26. 26.
    Tanaka H, Dinenno FA, Monahan KD et al (2000) Aging, habitual exercise, and dynamic arterial compliance. Circulation 102:1270–1275PubMedCrossRefGoogle Scholar
  27. 27.
    DeSouza CA, Shapiro LF, Clevenger CM et al (2000) Regular aerobic exercise prevents and restores age-related declines in endothelium-dependent vasodilation in healthy men. Circulation 102:1351–1357PubMedCrossRefGoogle Scholar
  28. 28.
    Gardin JM, Henry WL, Savage DD et al (1979) Echocardio-graphic measurements in normal subjects: evaluation of an adult population without clinically apparent heart disease. J Clin Ultrasound 7:439–447PubMedCrossRefGoogle Scholar
  29. 29.
    Bryg RJ, Williams GA, Labovitz AJ (1987) Effect of aging on left ventricular diastolic filling in normal subjects. Am J Cardiol 59:971–974PubMedCrossRefGoogle Scholar
  30. 30.
    Iskandrian AS, Aakki A (1986) Age related changes in left ventricular diastolic performance. Am Heart J 112:75–78PubMedCrossRefGoogle Scholar
  31. 31.
    Spirito P, Maron BJ (1988) Influence of aging on Doppler echocardiographic indices of left ventricular diastolic function. Br Heart J 59:672–679PubMedCrossRefGoogle Scholar
  32. 32.
    Miyatake K, Okamoto J, Kinoshita N et al (1984) Augmentation of atrial contribution to left ventricular flow with aging as assessed by intracardiac Doppler flowmetry. Am J Cardiol 53:587–589CrossRefGoogle Scholar
  33. 33.
    Sartori MP, Quinones MA, Kuo LC (1987) Relation of Doppler-derived left ventricular filling parameters to age and radius/thickness ratio in normal and pathologic states. Am J Cardiol 59:1179–1182PubMedCrossRefGoogle Scholar
  34. 34.
    Fleg JL, Shapiro EP, O’Connor F et al (1995) Left ventricular diastolic filling performance in older male athletes. JAMA 273:1371–1375PubMedCrossRefGoogle Scholar
  35. 35.
    Gardin JM, Rohan MK, Davidson DM et al (1987) Doppler transmitral flow velocity parameters: relationship between age, body surface area, blood pressure and gender in normal subjects. Am J Noninvasive Cardiol 1:3–10Google Scholar
  36. 36.
    Benjamin EG, Levy D, Anderson KM et al (1992) Determination of Doppler indexes of left ventricular diastolic function in normal subjects (the Framingham heart study). Am J Cardiol 70:508–515PubMedCrossRefGoogle Scholar
  37. 37.
    Villari B, Hess OM, Kaufmann P et al (1992) Effect of aortic valve stenosis (pressure overload) and regurgitation (volume overload) on left ventricular systolic and diastolic function. Am J Cardiol 69:927–934PubMedCrossRefGoogle Scholar
  38. 38.
    Prasad A, Popovic ZB, Arbab-Zadeh A et al (2007) The effects of aging and physical activity on Doppler measures of diastolic function. Am J Cardiol 99:1629–1636PubMedCrossRefGoogle Scholar
  39. 39.
    Lakatta EG (1980) Age-related alterations in the cardiovascular response to adrenergic mediated stress. Fed Proc 39:3173–3177PubMedGoogle Scholar
  40. 40.
    Robbins AS, Rubenstein LZ (1984) Postural hypotension in the elderly. J Am Geriatr Soc 32:769–774PubMedGoogle Scholar
  41. 41.
    Aronow WS, Lee NH, Sales FF et al (1988) Prevalence of postural hypotension in elderly patients in a long-term health care facility. Am J Cardiol 62:336PubMedCrossRefGoogle Scholar
  42. 42.
    Lipsitz LA, Jonsson PV, Marks BL et al (1990) Reduced supine cardiac volumes and diastolic filling rates in elderly patients with chronic medical conditions: implications for postural blood pressure homeostasis. J Am Geriatr Soc 38:103–107PubMedGoogle Scholar
  43. 43.
    Gribbin B, Pickering TG, Sleight P et al (1971) Effect of age and high blood pressure on baroreflex sensitivity in man. Circ Res 29:424–431PubMedCrossRefGoogle Scholar
  44. 44.
    Lipsitz LA, Nyquist RP Jr, Wei JY et al (1983) Postprandial reduction in blood pressure in the elderly. N Engl J Med 309:81–83PubMedCrossRefGoogle Scholar
  45. 45.
    Vaitkevicius PV, Esserwein DM, Maynard AK et al (1991) Frequency and importance of postprandial blood pressure reduction of elderly nursing-home patients. Ann Intern Med 115:865–870PubMedGoogle Scholar
  46. 46.
    Aronow WS, Ahn C (1994) Postprandial hypotension in 499 elderly persons in a long-term health care facility. J Am Geriatr Soc 42:930–932PubMedGoogle Scholar
  47. 47.
    Kamata T, Yokota T, Furukawa T et al (1994) Cerebral ischemic attack caused by postprandial hypotension. Stroke 25:511–513PubMedCrossRefGoogle Scholar
  48. 48.
    Aronow WS, Ahn C (1997) Association of postprandial hypotension with incidence of falls, syncope, coronary events, stroke, and total mortality at 29-month follow-up in 499 older nursing home residents. J Am Geriatr Soc 45:1051–1053PubMedGoogle Scholar
  49. 49.
    Wolf PA, Abbott RD, Kannel WB (1991) Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke 22:983–988PubMedCrossRefGoogle Scholar
  50. 50.
    Aronow WS, Ahn C, Gutstein H (1996) Prevalence of atrial fibrillation and association of atrial fibrillation with prior and new thromboembolic stroke in elderly patients. J Am Geriatr Soc 44:521–523PubMedGoogle Scholar
  51. 51.
    Kannel WB, Abbott RD, Savage DD et al (1982) Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med 306:1018–1022PubMedCrossRefGoogle Scholar
  52. 52.
    Aronow WS, Ahn C, Mercando AD et al (1995) Correlation of atrial fibrillation, paroxysmal supraventricular tachycardia, and sinus rhythm with incidences of new coronary events in 1359 patients, mean age 81 years, with heart disease. Am J Cardiol 75:182–184PubMedCrossRefGoogle Scholar
  53. 53.
    Poliner LR, Dehmer GJ, Lewis SE et al (1980) Left ventricular performance in normal subjects: a comparison of the responses to exercise in the upright and supine positions. Circulation 62:528–534PubMedCrossRefGoogle Scholar
  54. 54.
    Fraticelli A, Josephson R, Danziger R et al (1989) Morphological and contractile characteristics of rat cardiac myocytes from maturation to senescence. Am J Physiol 257:H259–H265PubMedGoogle Scholar
  55. 55.
    Capasso JM, Malhotra A, Remly RM (1983) Effects of age on mechanical and electrical performance of rat myocardium. Am J Physiol 245:H72–H81PubMedGoogle Scholar
  56. 56.
    Willems JL, Roelandt H, DeGeest H et al (1970) The left ventricular ejection time in elderly subjects. Circulation 42:37–42PubMedCrossRefGoogle Scholar
  57. 57.
    Shaw DJ, Rothbaum DA, Angell CS et al (1973) The effect of age and blood pressure upon the systolic time intervals in males aged 20–89 years. J Gerontol 28:133–139PubMedCrossRefGoogle Scholar
  58. 58.
    Lakatta EG (1987) Do hypertension and aging have similar effects on the myocardium? Circulation 75(suppl 1):69–77Google Scholar
  59. 59.
    Lakatta EG, Yin FCP (1982) Myocardial aging: functional alterations and related cellular mechanisms. Am J Physiol 242:H927–H941PubMedGoogle Scholar
  60. 60.
    Port S, Cobb FR, Coleman RE et al (1980) Effect of age on the response of the left ventricular ejection fraction to exercise. N Engl J Med 303:1133–1137PubMedCrossRefGoogle Scholar
  61. 61.
    Aronow WS, Stein PD, Sabbah HN et al (1989) Resting left ventricular ejection fraction in elderly patients without evidence of heart disease. Am J Cardiol 63:368–369PubMedCrossRefGoogle Scholar
  62. 62.
    Fleg JL, Schulman S, O’Connor F et al (1994) Effect of acute β-adrenergic receptor blockade on age-associated changes in cardiovascular performance during dynamic exercise. Circulation 90:2333–2341PubMedCrossRefGoogle Scholar
  63. 63.
    Tresch DD, McGough MF (1995) Heart failure with normal systolic function: a common disorder in older people. J Am Geriatr Soc 43:1035–1042PubMedGoogle Scholar
  64. 64.
    Wei JY, Spurgeon HA, Lakatta EG (1984) Excitation-contraction in rat myocardium: alterations with adult aging. Am J Physiol 246:H784–H791PubMedGoogle Scholar
  65. 65.
    Morgan JP, Morgan KG (1984) Calcium and cardiovascular function: intracellular calcium levels during contraction and relaxation of mammalian cardiac and vascular smooth muscle as detected with aequorin. Am J Med 77(suppl 5A):33–46PubMedCrossRefGoogle Scholar
  66. 66.
    Bandy B, Davison AJ (1990) Mitochondrial mutations may increase oxidative stress: implications for carcinogenesis and aging? Free Radic Biol Med 8:523–539PubMedCrossRefGoogle Scholar
  67. 67.
    Corral-Debrinski M, Stepien G, Shoffner JM et al (1991) Hypoxemia is associated with mitochondrial DNA damage and gene induction: implications for cardiac disease. JAMA 266:1812–1816PubMedCrossRefGoogle Scholar
  68. 68.
    Lie JT, Hammond PI (1988) Pathology of the senescent heart: anatomic observations on 237 autopsy studies of patients 90 to 105 years old. Mayo Clin Proc 63:552–564PubMedCrossRefGoogle Scholar
  69. 69.
    Schaub MC (1964) The aging of collagen in the heart muscle. Gerontologia 10:38–41PubMedCrossRefGoogle Scholar
  70. 70.
    Verzar F (1969) The stages and consequences of aging collagen. Gerontologia 15:233–239PubMedCrossRefGoogle Scholar
  71. 71.
    Hachamovitch R, Wicker P, Capasso JM et al (1989) Alterations of coronary blood flow and reserve with aging in Fischer 344 rats. Am J Physiol 256:H66–H73PubMedGoogle Scholar
  72. 72.
    Ogawa T, Spina R, Martin WH III et al (1992) Effects of aging, sex and physical training on cardiovascular responses to exercise. Circulation 86:494–503PubMedCrossRefGoogle Scholar
  73. 73.
    Manning WJ, Shannon RP, Santinga JA et al (1989) Reversal of changes in left ventricular diastolic filling associated with normal aging using diltiazem. Am J Cardiol 67:894–896CrossRefGoogle Scholar
  74. 74.
    Kitzman DW, Higginbotham MB, Cobb FR et al (1991) Exercise intolerance in patients with heart failure and preserved left ventricular systolic function: failure of the Frank–Starling mechanism. J Am Coll Cardiol 17:1065–1072PubMedCrossRefGoogle Scholar
  75. 75.
    Aronow WS, Ahn C, Kronzon I (1998) Normal left ventricular ejection fraction in older persons with congestive heart failure. Chest 113:867–869PubMedCrossRefGoogle Scholar
  76. 76.
    Aronow WS, Ahn C, Gutstein H (2002) Prevalence and incidence of cardiovascular disease in 1160 older men and 2464 older women in a long-term health care facility. J Gerontol A Biol Med Sci 57:M45–M46CrossRefGoogle Scholar
  77. 77.
    Wong WF, Gold S, Fukuyama O et al (1989) Diastolic dysfunction in elderly patients with congestive heart failure. Am J Cardiol 63:1526–1528PubMedCrossRefGoogle Scholar
  78. 78.
    Aronow WS, Ahn C, Kronzon I (1990) Prognosis of congestive heart failure in elderly patients with normal versus abnormal left ventricular systolic function associated with coronary artery disease. Am J Cardiol 66:1257–1259PubMedCrossRefGoogle Scholar
  79. 79.
    Kitzman DW, Gardin JM, Arnold A et al (1996) Heart failure with preserved systolic LV function in the elderly: clinical and echocardiographic correlates from the Cardiovascular Health Study (abstract). Circulation 94(suppl 1):I433Google Scholar
  80. 80.
    Vasan RS, Benjamin EJ, Evans JC et al (1995) Prevalence and clinical correlates of diastolic heart failure: Framingham heart study (abstract). Circulation 92(suppl 1):666Google Scholar
  81. 81.
    Pernenkil R, Vinson JM, Shah AS et al (1997) Course and prognosis in patients ≥70 years of age with congestive heart failure and normal versus abnormal left ventricular ejection fraction. Am J Cardiol 79:216–219PubMedCrossRefGoogle Scholar
  82. 82.
    Aronow WS, Ahn C, Kronzon I (1999) Comparison of incidences of congestive heart failure in older African-Americans, Hispanics, and whites. Am J Cardiol 84:611–612PubMedCrossRefGoogle Scholar
  83. 83.
    Redfield MM, Jacobsen SJ, Borlaug BA et al (2005) Age-and gender-related ventricular-vascular stiffening. A community-based study. Circulation 112:2254–2262PubMedCrossRefGoogle Scholar
  84. 84.
    Konstam MA, Dracup K, Baker DW et al (1994) Heart failure: management of patients with left-ventricular systolic dysfunction. Quick Reference Guide for Clinicians, No. 11, AHCPR Publication No. 94-0613. Agency for Health Care Policy and Research, Rockville, MD, June 1994, pp 1–21Google Scholar
  85. 85.
    Aronow WS (1994) Echocardiography should be performed in all elderly patients with congestive heart failure. J Am Geriatr Soc 42:1300–1302PubMedGoogle Scholar
  86. 86.
    Williams JF Jr, Bristow MR, Fowler MB et al (1995) Guidelines for the evaluation and management of heart failure. Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Evaluation and Management of Heart Failure). J Am Coll Cardiol 26:1376–1398CrossRefGoogle Scholar
  87. 87.
    American Medical Directors Association (1996) Heart failure. Clinical practice guideline. American Medical Directors Association, Columbia, MD, pp 1–8Google Scholar
  88. 88.
    Aronow WS (1998) Commentary on American Geriatrics Society Clinical Practice Guidelines from AHCPR Guidelines on Heart Failure: Evaluation and Treatment of Patients with Left Ventricular Systolic Dysfunction. J Am Geriatr Soc 46:525–529Google Scholar
  89. 89.
    Aronow WS (1991) Digoxin or angiotensin converting enzyme inhibitors for congestive heart failure in geriatric patients: which is the preferred treatment? Drugs Aging 1:98–103PubMedCrossRefGoogle Scholar
  90. 90.
    Rich MW, McSherry F, Williford WO et al (2001) Effect of age on mortality, hospitalizations and response to digoxin in patients with heart failure: the DIG study. J Am Coll Cardiol 38:806–813PubMedCrossRefGoogle Scholar
  91. 91.
    Ahmed A, Aronow WS, Fleg JL (2006) Predictors of mortality and hospitalization in women with heart failure in the Digitalis Investigation Group trial. Am J Ther 13:325–331PubMedCrossRefGoogle Scholar
  92. 92.
    Ahmed A, Rich MW, Fleg JL et al (2006) Effects of digoxin on morbidity and mortality in diastolic heart failure. The Ancillary Digitalis Investigation Group trial. Circulation 114:397–403PubMedCrossRefGoogle Scholar
  93. 93.
    Ahmed A, Zile MR, Rich MW et al (2007) Hospitalizations due to unstable angina pectoris in diastolic and systolic heart failure. Am J Cardiol 99:460–464PubMedCrossRefGoogle Scholar
  94. 94.
    Hunt SA, Abraham WT, Feldman AM et al (2005) ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult – summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). Developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation. Endorsed by the Heart Rhythm Society. J Am Coll Cardiol 46:1116–1143CrossRefGoogle Scholar
  95. 95.
    Aronow WS (2006) Epidemiology, pathophysiology, prognosis, and treatment of systolic and diastolic heart failure. Cardiol Rev 14:108–124PubMedCrossRefGoogle Scholar
  96. 96.
    Fleg JL (1986) Alterations in cardiovascular structure and function with advancing age. Am J Cardiol 57:33C–44CPubMedCrossRefGoogle Scholar
  97. 97.
    Dehn MM, Bruce RA (1972) Longitudinal variations in maximal oxygen intake with age and activity. J Appl Physiol 33:805–807PubMedGoogle Scholar
  98. 98.
    Heath GW, Hagberg JM, Ehsani AA (1981) A physiological comparison of young and older endurance athletes. J Appl Physiol 51:634–640PubMedGoogle Scholar
  99. 99.
    Fleg JL, Schulman SP, O’Connor FC et al (1994) Cardiovascular responses to exhaustive upright cycle exercise in highly trained older men. J Appl Physiol 77:1500–1506PubMedGoogle Scholar
  100. 100.
    Forman DE, Manning WJ, Hauser R et al (1992) Enhanced left ventricular diastolic filling associated with long-term endurance training. J Gerontol 47:M56–M58PubMedCrossRefGoogle Scholar
  101. 101.
    Woo JS, Derleth C, Stratton JR, Levy WC (2006) The influence of age, gender, and training on exercise efficiency. J Am Coll Cardiol 47:1049–1057PubMedCrossRefGoogle Scholar
  102. 102.
    Julius S, Amery A, Whitlock LS et al (1967) Influence of age on the hemodynamic response to exercise. Circulation 36:222–230PubMedCrossRefGoogle Scholar
  103. 103.
    Fleg JL, Lakatta EG (1988) Role of muscle loss in the age-associated reduction in VO2max. J Appl Physiol 65:1147–1151PubMedGoogle Scholar
  104. 104.
    Fleg JL, O’Connor F, Gerstenblith G et al (1995) Impact of age on the cardiovascular response to dynamic upright exercise in healthy men and women. J Appl Physiol 78:890–900PubMedGoogle Scholar
  105. 105.
    Chauhan A, More RS, Mullins PA et al (1996) Aging-associated endothelial dysfunction in humans is reversed by larginine. J Am Coll Cardiol 28:1796–1804PubMedCrossRefGoogle Scholar
  106. 106.
    Elkayam U, Amin J, Mehra A et al (1990) A prospective, randomized, double-blind, crossover study to compare the efficacy and safety of chronic nifedipine therapy with that of isosorbide dinitrate and their combination in the treatment of chronic congestive heart failure. Circulation 82:1954–1961PubMedCrossRefGoogle Scholar
  107. 107.
    Multicenter Diltiazem Postinfarction Trial Research Group (1988) The effect of diltiazem on mortality and reinfarction after myocardial infarction. N Engl J Med 319:385–392CrossRefGoogle Scholar
  108. 108.
    Goldstein RE, Boccuzzi SJ, Cruess D et al (1991) Diltiazem increases late-onset congestive heart failure in postinfarction patients with early reduction in ejection fraction. Circulation 83:52–60PubMedCrossRefGoogle Scholar
  109. 109.
    Packer M, O’Connor CM, Ghali JK et al (1996) Effect of amlodipine on morbidity and mortality in severe chronic heart failure. N Engl J Med 335:1107–1114PubMedCrossRefGoogle Scholar
  110. 110.
    Cohn JN, Ziesche SM, Loss LE et al (1997) Effect of the calcium antagonist felodipine as supplementary vasodilator therapy in patients with chronic heart failure treated with enalapril. V-HeFT III. Circulation 96:856–863PubMedCrossRefGoogle Scholar
  111. 111.
    Garg R, Yusuf S (1995) Collaborative Group on ACE Inhibitor Trials. Overview of randomized trials of angiotensin-converting enzyme inhibitory on mortality and morbidity in patients with heart failure. JAMA 273:1450–1456PubMedCrossRefGoogle Scholar
  112. 112.
    Pitt B, Segal R, Martinez FA et al (1997) Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE). Lancet 349:747–752PubMedCrossRefGoogle Scholar
  113. 113.
    MERIT-HF Study Group (1999) Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 353:2001–2007CrossRefGoogle Scholar
  114. 114.
    Packer M, Coats AJS, Fowler MB et al (2001) Effect of carvedilol on survival in chronic heart failure. N Engl J Med 344:651–658CrossRefGoogle Scholar
  115. 115.
    CIBIS-II Investigators and Committees (1999) The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet 353:9–13CrossRefGoogle Scholar
  116. 116.
    Flather MD, Shibata MC, Coats AJS et al (2005) Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J 26:215–225PubMedCrossRefGoogle Scholar
  117. 117.
    Granger CB, McMurray JJV, Yusuf S et al (2003) Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial. Lancet 362:772–776PubMedCrossRefGoogle Scholar
  118. 118.
    Aronow WS (2001) Exercise therapy for older persons with cardiovascular disease. Am J Geriatr Cardiol 10:245–252PubMedCrossRefGoogle Scholar
  119. 119.
    Bardy GH, Lee KL, Mark DB et al (2005) Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Eng J Med 352:225–237CrossRefGoogle Scholar
  120. 120.
    Aronow WS (2005) CRT plus ICD in congestive heart failure. Use of cardiac resynchronization therapy and an implantable cardioverter-defibrillator in heart failure patients with abnormal left ventricular dysfunction. Geriatrics 60(2):24–28PubMedGoogle Scholar
  121. 121.
    Cleland JGF, Daubert J-C, Erdmann E et al (2005) The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 352:1539–1549PubMedCrossRefGoogle Scholar
  122. 122.
    Pitt B, Zannad F, Remme WJ et al (1999) The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med 341:709–717PubMedCrossRefGoogle Scholar
  123. 123.
    Pitt B, Remme W, Zannad F et al (2003) Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 348:1309–1321PubMedCrossRefGoogle Scholar
  124. 124.
    Taylor AL, Ziesche S, Yancy C et al (2004) Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. N Engl J Med 351:2049–2057PubMedCrossRefGoogle Scholar
  125. 125.
    Aronow WS (2005) Race, drugs, and heart failure. Geriatrics 60(7):8–9PubMedGoogle Scholar
  126. 126.
    Rathore SS, Curtis JP, Wang Y et al (2003) Association of serum digoxin concentration and outcomes in patients with heart failure. JAMA 289:871–878PubMedCrossRefGoogle Scholar
  127. 127.
    Ahmed A, Aban IB, Weaver MT et al (2006) Serum digoxin concentration and outcomes in women with heart failure: a bi-directional effect and a possible effect modification by ejection fraction. Eur J Heart Fail 8:409–441PubMedCrossRefGoogle Scholar
  128. 128.
    Bolli R, Anversa P (2007) Stem cells and cardiac aging. In: Leri A, Anversa P, Frishman WH (eds) Cardiovascular regeneration and stem cell therapy. Blackwell Futura, Malden, MA, pp 171–181CrossRefGoogle Scholar
  129. 129.
    Aronow WS, Ahn C, Kronzon I (1997) Effect of propranolol versus no propranolol on total mortality plus nonfatal myocardial infarction in older patients with prior myocardial infarction, congestive heart failure, and left ventricular ejection fraction ≥40% treated with diuretics plus angiotensin-converting-enzyme inhibitors. Am J Cardiol 80:207–209PubMedCrossRefGoogle Scholar
  130. 130.
    Aronow WS, Kronzon I (1993) Effect of enalapril on congestive heart failure treated with diuretics in elderly patients with prior myocardial infarction and normal left ventricular ejection fraction. Am J Cardiol 71:602–604PubMedCrossRefGoogle Scholar
  131. 131.
    Cleland JG, Tendera M, Adamus J et al (2006) The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J 27:2257–2259CrossRefGoogle Scholar
  132. 132.
    Yusuf S, Pfeffer MA, Swedberg K et al (2003) Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved trial. Lancet 362:777–781PubMedCrossRefGoogle Scholar
  133. 133.
    Aronow WS, Ahn C, Schoenfeld MR, Gutstein H (1999) Association of extracranial carotid arterial disease and chronic atrial fibrillation with the incidence of new thromboembolic stroke in 1,846 older persons. Am J Cardiol 83:1403–1404PubMedCrossRefGoogle Scholar
  134. 134.
    Aronow WS, Ahn C, Kronzon I (2001) Comparison of echocardiographic abnormalities in African-American, Hispanic, and white men and women aged >60 years. Am J Cardiol 87:1131–1133PubMedCrossRefGoogle Scholar
  135. 135.
    Roberts WC, Perloff JK, Costantino T (1971) Severe valvular aortic stenosis in patients over 65 years of age. Am J Cardiol 27:497–506PubMedCrossRefGoogle Scholar
  136. 136.
    Waller BF, Roberts WC (1983) Cardiovascular disease in the very elderly: an analysis of 40 necropsy patients aged 90 years or over. Am J Cardiol 51:403–421PubMedCrossRefGoogle Scholar
  137. 137.
    Aronow WS, Schwartz KS, Koenigsberg M (1987) Correlation of serum lipids, calcium, and phosphorus, diabetes mellitus and history of systemic hypertension with presence or absence of calcified or thickened aortic cusps or root in elderly patients. Am J Cardiol 59:998–999PubMedCrossRefGoogle Scholar
  138. 138.
    Shirani J, Yousefi J, Roberts WC (1995) Major cardiac findings at necropsy in 366 American octogenarians. Am J Cardiol 75:151–156PubMedCrossRefGoogle Scholar
  139. 139.
    Lindroos M, Kupari M, Heikkila J et al (1993) Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample. J Am Coll Cardiol 21:1220–1225PubMedCrossRefGoogle Scholar
  140. 140.
    Aronow WS, Kronzon I, Schoenfeld MR (1995) Prevalence of extracranial carotid arterial disease and of valvular aortic stenosis and their association in the elderly. Am J Cardiol 75:304–305PubMedCrossRefGoogle Scholar
  141. 141.
    Aronow WS, Ahn C, Kronzon I (2001) Association of valvular aortic stenosis with symptomatic peripheral arterial disease in older persons. Am J Cardiol 88:1046–1047PubMedCrossRefGoogle Scholar
  142. 142.
    Nassimiha D, Aronow WS, Ahn C, Goldman ME (2001) Rate of progression of valvular aortic stenosis in persons ≥60 years. Am J Cardiol 87:807–809PubMedCrossRefGoogle Scholar
  143. 143.
    Nassimiha D, Aronow WS, Ahn C, Goldman ME (2001) Association of coronary risk factors with progression of valvular aortic stenosis in older persons. Am J Cardiol 87:1313–1314PubMedCrossRefGoogle Scholar
  144. 144.
    Palta S, Pai AM, Gill KS, Pai RG (2000) New insights into the progression of aortic stenosis. Implications for secondary prevention. Circulation 101:2497–2502PubMedCrossRefGoogle Scholar
  145. 145.
    Aronow WS, Schwartz KS, Koenigsberg M (1987) Correlation of serum lipids, calcium and phosphorus, diabetes mellitus, aortic valve stenosis and history of systemic hypertension with presence or absence of mitral anular calcium in persons older than 62 years in a long-term health care facility. Am J Cardiol 59:381–382PubMedCrossRefGoogle Scholar
  146. 146.
    Aronow WS, Ahn C, Shirani J, Kronzon I (1998) Comparison of frequency of new coronary events in older persons with mild, moderate, and severe valvular aortic stenosis with those without aortic stenosis. Am J Cardiol 81:647–649PubMedCrossRefGoogle Scholar
  147. 147.
    Livanainen AM, Lindroos M, Tilvis R et al (1996) Natural history of aortic valve stenosis of varying severity in the elderly. Am J Cardiol 78:97–101CrossRefGoogle Scholar
  148. 148.
    Otto CM, Lind BK, Kitzman DW et al (1999) Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 341:142–147PubMedCrossRefGoogle Scholar
  149. 149.
    Aronow WS (1999) Shirani J, Kronzon I. Comparison of frequency of new coronary events in older subjects with and without valvular aortic sclerosis. Am J Cardiol 83:599–600PubMedCrossRefGoogle Scholar
  150. 150.
    Margonato A, Cianflone D, Carlino M et al (1989) Frequence and significance of aortic valve thickening in older asymptomatic patients and its relation to aortic regurgitation. Am J Cardiol 64:1061–1062PubMedCrossRefGoogle Scholar
  151. 151.
    Akasaka T, Yoshikawa J, Yoshida K et al (1987) Age-related valvular regurgitation: a study by pulsed Doppler echocardiography. Circulation 76:262–265PubMedCrossRefGoogle Scholar
  152. 152.
    Aronow WS, Kronzon I (1989) Correlation of prevalence and severity of aortic regurgitation detected by pulsed Doppler echocardiography with the murmur of aortic regurgitation in elderly patients in a long-term health care facility. Am J Cardiol 63:128–129PubMedCrossRefGoogle Scholar
  153. 153.
    Sell S, Scully RE (1965) Aging changes in the aortic and mitral valves. Am J Pathol 46:345–365PubMedGoogle Scholar
  154. 154.
    Pomerance A, Darby AJ, Hodkinson HM (1978) Valvular calcification in the elderly: possible pathogenic factors. J Gerontol 33:672–676PubMedCrossRefGoogle Scholar
  155. 155.
    Roberts WC (1986) The senile cardiac calcification syndrome. Am J Cardiol 58:572–574PubMedCrossRefGoogle Scholar
  156. 156.
    Aronow WS, Schwartz KS, Koenigsberg M (1987) Correlation of atrial fibrillation with presence of absence of mitral annular calcium in 604 persons older than 60 years. Am J Cardiol 59:1213–1214PubMedCrossRefGoogle Scholar
  157. 157.
    Roberts WC, Perloff JK (1972) Mitral valvular disease: a clinicopathologic survey of the conditions causing the mitral valve to function abnormally. Ann Intern Med 77:939–975PubMedGoogle Scholar
  158. 158.
    Aronow WS, Ahm C, Kronzon I (1999) Association of mitral annular calcium and of aortic cuspal calcium with coronary artery disease in older patients. Am J Cardiol 84:1084–1085PubMedCrossRefGoogle Scholar
  159. 159.
    Adler Y, Herz I, Vaturi M et al (1998) Mitral annular calcium detected by transthoracic echocardiography is a marker for high prevalence and severity of coronary artery disease in patients undergoing coronary angiography. Am J Cardiol 82:1183–1186PubMedCrossRefGoogle Scholar
  160. 160.
    Tolstrup K, Roldan CA, Qualls CR, Crawford MH (2002) Aortic valve sclerosis, mitral annular calcium, and aortic root sclerosis as markers of atherosclerosis in men. Am J Cardiol 89:1030–1034PubMedCrossRefGoogle Scholar
  161. 161.
    Aronow WS, Ahn C, Kronzon I (2001) Association of mitral annular calcium with symptomatic peripheral arterial disease in older persons. Am J Cardiol 88:333–334PubMedCrossRefGoogle Scholar
  162. 162.
    Antonini-Canterin F, Capanna M, Manfroni A, Brieda M, Grandis U, Sbaraglia F, Cervesato E, Pavan D, Nicolosi GL (2001) Association between mitral annular calcium and carotid artery stenosis and role of age and gender. Am J Cardiol 88:581–583PubMedCrossRefGoogle Scholar
  163. 163.
    Seo Y, Ishimitsu T, Ishizu T et al (2005) Relationship between mitral annular calcification and severity of carotid atherosclerosis in patients with symptomatic ischemic cerebrovascular disease. J Cardiol 46:17–24PubMedGoogle Scholar
  164. 164.
    Kistler PM, Sanders P, Fynn SP et al (2004) Electrophysiologic and electroanatomic changes in the human atrium associated with aging. J Am Coll Cardiol 44:109–116PubMedCrossRefGoogle Scholar
  165. 165.
    Aronow WS (1991) Correlation of arrhythmias and conduction defects on the resting electrocardiogram with new cardiac events in 1,153 elderly patients. Am J Noninvasive Cardiol 75:182–184CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Cardiology DivisionNew York Medical CollegeValhallaUSA

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