Summary
The basic mechanisms that cause aging are still poorly understood. Longitudinal prospective population studies using noninvasive examination techniques have improved our ability to differentiate between aging and disease. This review describes some general morphological and functional aging-related changes of the heart that have clinical relevance, and considers the possibility of drug treatment for the manifestations of aging per se.
Digitalis has not been shown to improve the aging-related decline in myocardial strength and contractility. During aging, heart tissue stiffens and the speed and extent of diastolic filling decline. The latter is a limiting functional factor, particularly during increases in heart rate. Lowering peripheral vascular resistance, which is often increased in older people, might indirectly improve heart function. However, no drug has been shown to improve myocardial strength or lower tissue stiffness via a direct effect on the heart. It has been claimed, however, that calcium antagonists might improve diastolic filling.
Morphological changes during aging are dominated by some left ventricular wall and septal hypertrophy, and left atrial and ventricular widening. Recent findings have suggested that angiotensin II might act as a growth stimulating factor, promoting cardiac hypertrophy. This has led to speculation that ACE inhibitors might contribute to the restructuring of the heart, not only in hypertension but also in patients with the common combination of slightly elevated blood pressure and aging-related myocardial hypertrophy.
At present, it appears that improving exogenous factors (e.g. lifestyle, living circumstances and access to adequate medical care) offers greater opportunities for postponing cardiac aging than drugs that directly interfere with the physiological aging of the heart.
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References
Elveback L, Lie JT. Continued high incidence of coronary artery disease at autopsy in Olmsted County, Minnesota, 1950 to 1979. Circulation 1984; 70: 345–9
Svanborg A. A medical-social intervention in a 70-year-old Swedish population: is it possible to postpone functional decline in aging? J Gerontol 1993; 48 Spec. Iss.: 84–8
Steen B. Body composition and aging. In: Proceedings of Nutrition and Aging Symposium; Marabou Sundbyberg Sweden 1987: 13–9
Grimby G, Saltin B. The aging muscle. Clin Physiol Oxy 1983; 3: 209–18
Unverferth DB, Baker PB, Anthony RA, et al. Aging of the human myocardium: a histologic study based upon endomyocardial biopsy. Gerontology 1986; 32: 241–51
Anversa FT, Palackal EH, Sonnenblick EH, et al. Myocyte cell loss and myocyte cellular hyperplasia in the hypertrophied aging rat heart. Circ Res 1990; 67: 871–85
Kitzman DW, Scholz DG, Hagen DM, et al. Age-related changes in normal human hearts during the first ten decades. Part II (maturity): a quantitative anatomic study of 765 specimens from subjects 20 to 99 years old. Mayo Clin Proc 1988; 63: 137–46
Lie JT, Hammond PT. Pathology of the senescent heart: observations in autopsy studies of patients 90–105 years old. Mayo Clin Proc 1988; 63: 35–6
Verzar F. Das alterndes collagens. Helv Physiol Acta 1956; 14: 207–20
Viidik A. Age-related changes in connective tissue. In: Viidik A, editor. Lectures in gerontology. Vol. 1. On biology of aging, part A. London: Academic Press, 1982: 173–211
Kovanen V, Suominen H. Age and training-related changes in the collagen metabolism of rat skeletal muscle. Eur J Appl Physiol 1989; 58: 765–71
Montford I, Perez-Tamayo R. The muscle collagen ratio in normal and hypertrophic human hearts. Lab Invest 1962; 11: 463–70
Leukiewicz JE, Davies MJ, Rosen D. Collagen in human myocardium as a function of age. Cardiovasc Res 1972; 6: 549–55
Montford I, Perez-Tamayo R. The muscle-collagen ratio in normal and hypertrophie human hearts. Lab Invest 1962; 11: 463–70
Berman ND. Aging and the heart. In: Geriatric cardiology. Lexington (KY): Collamore, 1982: 11–20
Landahl S, Bengtsson C, Sigurdsson JA, et al. Age-related changes in blood pressure. Hypertension 1986; 8: 1044–9
Gardin JM, Henry WL, Savage DD, et al. Echocardiographic measurements in normal subjects: evaluation of an adult population without chemically apparent heart disease. J Clin Ultrasound 1979; 7: 439–47
Gardin JM, Savage DD, Ware JH, et al. Effect of age, sex and body surface area on echocardiographic left ventricular mass in normal subjects. Hypertension 1987; 9 Suppl. II: 1136–9
Lernfelt BS, Wikstrand J, Svanborg A, et al. Aging and left ventricular function in elderly healthy people. Am J Cardiol 1991; 68: 547–9
Gerstenblith G. Noninvasive assessment of cardiac function in the elderly. In: Weisfeldt ML, editor. The aging heart: its function and response to stress. New York: Raven, 1980: 247–68
Gerstenblith G, Fredricksen J, Yin FCP, et al. Echocardiographic assessment of a normal adult aging population. Circulation 1977; 56: 273–8
Heikkinen E, Arajä R-L, Era P, et al. Functional capacity of men born in 1906–1910, 1926–30 and 1946–50: a basic report. Scand J Med 1984; 33 Suppl.: 1–97
Lakatta EG. Cardiac muscle changes in senescence. Annu Rev Physiol 1987; 49: 519–31
Ensor RE, Fleg JL, Kim YC, et al. Longitudinal chest x-ray changes in normal men. J Gerontol 1983; 38: 307–14
Landahl S, Svanborg A, Astrand K. Heart volume and the prevalence of certain common cardiovascular disorders at 70 and 75 years of age. Eur Heart J 1984; 5: 326–31
Roberts J, Goldberg PB. Changes in basic cardiovascular activities during the life time of the rat. Exp Aging Res 1976; 2: 487–512
Roberts J, Goldberg PB. Changes in responsiveness of the heart to drugs during aging. Fed Proc 1979; 38: 1927–32
Weisfeldt ML, editor. The aging heart: its function and response to stress. New York: Raven 1980
Fleg JL. Alterations in cardiovascular structure and function with advancing age. Am J Cardiol 1986; 57: 33–44
Lakatta EG. Alterations in the cardiovascular system that occur in advanced age. Fed Proc 1979; 38: 163–7
Lakatta EG. Cardiac muscle changes in senescence. Annu Rev Physiol 1987; 49: 519–39
Lakatta EG. Changes in cardiovascular function with aging. Eur Heart J 1990; 11 Suppl. C: 22–8
Lakatta EG. Cardiovascular regulatory mechanisms in advanced age. Physiol Rev 1993 Apr; 73(2): 413–67
Folkow B, Svanborg A. Physiology of cardiovascular aging. Physiol Rev 1993 Oct; 73(4): 725–64
Cotman CW. Synaptic plasticity, neurotrophic factors and transplantation in the aged brain. In: Schneider EL, Rowe JW, editors. Handbook of the biology of man. San Diego (CA): Academic 1990: 255–74
Davies MJ. Pathology of the conduction system. In: Caird FL, Dall JLC, Kennedy RD. Cardiology in old age. New York: Plenum, 1976: 57–80
Fleg JL, Das DN, Wright J, et al. Age-associated changes in the components of atrioventricular conduction in apparently healthy volunteers. J Gerontol 1990 May; 45(3): M95–100
Jose AD, Collison D. The normal range and determinants of the intrinsic heart rate in man. Cardiovasc Res 1970; 4: 160–7
Saltin B. The aging endurance athlete. In: Sutton JR, Brock RM, editors. Sports medicine for the mature athlete. Indianapolis (IN): Benchmark 1986: 59–80
Fleg JL. Cardiac arrhythmias in a healthy elderly population: detection by 24-hour ambulatory electrocardiography. Chest 1982; 81: 302–7
Hort W, Strunk W, Eckner FAO, et al. Pathologisch-anatomische Befunde beim plötzlichen Herztod. Z Kardiol 1989; 78: 619–32
Schmidt P, Haarhoff K, Bonte W. Sudden natural death at the wheel: a particular problem of the elderly. Forensic Sci Int 1990; 48: 155–62
Ferrari AU, Grassi G, Mancia G. Alterations in reflex control of circulation with aging. In: Avery A, Stassen S, editors. Hypertension in the elderly: handbook of hypertension. Amsterdam: Elsevier, 1989: 39–50
Mancia G, Mark AL. Chapter 20: arterial baroreflexes in humans. In: Handbook of physiology: the cardiovascular system. Peripheral circulation and organ blood flow. Bethesda (MD): American Physiology Society, 1983: 755–94
Mark AL, Mancia G. Chapter 21: cardiopulmonary baroreflex in humans. In: Handbook of physiology: the cardiovascular system. Peripheral circulation and organ blood flow. Bethesda (MD): American Physiology Society, 1983: 795–813
Shannon RP, Wei JY, Rosa RM, et al. The effect of age and sodium depletion on cardiovascular response to orthostasis. Hypertension 1986; 8: 438–43
Folkow B. Relevance of cardiovascular receptors [invited lecture]. In: Hainsworth R, Kidd C, Linden RJ, editors. Cardiac receptors. Cambridge: Cambridge University Press 1980: 473–505
Grassi G, Giannattasio C, Saino A, et al. Cardiopulmonary receptor modulation of plasma renin activity in normotensive and hypertensive subjects. Hypertension 1988; 11: 92–9
Granath A, Jonsson B, Strandeil T. Circulation in healthy old men studied by right heart catheterization at rest and during exercise in supine and sitting positions. Acta Med Scand 1964; 176: 425–46
Strandell T. Circulatory studies on healthy old men. Acta Med Scand 1964; 176 Suppl. 414: 1–44
Strandell T. Cardiac output in old age. In: Caird FI, Dall JLC, Kennedy RD, editors. Cardiology in old age. New York: Plenum, 1976: 81–95
Strandell T. Are there signs of incipient cardiac insufficiency in healthy elderly men? Symposium on incipient cardiac insufficiency. Basle: Sandoz 1970: 203–8
Rich IF. Ophthalmology: normal changes in the aging eye. In: Cassel CK, Walsh JR. Geriatric medicine, medical, psychiatric and pharmacological topics. Vol. 1. New York: Springer-Verlag, 1982: 92–3
Manning WJ, Shannon RP, Santinga JA, et al. Reversal of changes in left ventricular diastolic filling associated with normal aging using diltiazem. Am J Cardiol 1991; 67: 894–6
Arrighi JA, Dilsizian V, Perrone-Filardi P, et al. Improvement of the age-related impairment in left ventricular diastolic filling with verapamil in the normal human heart. Circulation 1994; 90(1): 213–9
Xiao R-P, Lakatta EG. Uncoupling of the B2-adrenoceptor effect on Ca2+regulation and cAMP in cardiac cells. In: Eudeoh M, Morad M, Schols H, et al., editors. Molecular and cellular mechanisms of cardiovascular regulation. Tokyo: Springer Verlag 1996
Bruet-Saert DL, Sys SV. Relaxation and diastole of the heart. Physiol Rev 1989; 60: 1228–1315
Nakashima Y, Nii T, Ikeda M, et al. Role of left ventricular regional nonuniformity in hypertensive diastolic dysfunction. J Am Coll Cardiol 1993; 22: 790–5
Lakatta EG. Chaotic behavior of myocardial cells: possible implications regarding the pathophysiology of heart failure. Perspect Biol Med 1989; 32: 421–33
van den Meiracker AH, Man in’t Veld AJ, van Eck HJ, et al. Hemodynamic and hormonal adaptations to beta-adrenoceptor blockade: a 24-hour study of acebutolol, atenolol, pindolol, and propranolol in hypertensive patients. Circulation 1988; 78: 957–68
Sagie A, Benjamin EJ, Galderisi M, et al. Reference values for doppler indexes of left ventricular diastolic filling in the elderly. J Am Soc Echocardiogr 1993 Nov-Dec; 6(6): 570–6
Tresch DD, McGough MF. Heart failure with normal systolic function: a common disorder in older people. J Am Geriatr Soc 1995; 43: 1035–42
Waagstein F, Bristow MR, Swedberg K, et al. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Lancet 1993; 342: 1441–6
Schulman SP, Lakatta EG, Fleg JL, et al. Age-related decline in left ventricular filling at rest and exercise. Am J Physiol 1992; 263(6 Pt 2):H1932–8
Dzau VJ. Circulating versus local renin-angiotensin system in cardiovascular homeostasis. Circulation 1988; 77 Suppl. I: 14–17
Lindpainter K, Ganten D. The cardiac renin-angiotensin system: an appraisal of present experimental and clinical evidence. Circ Res 1991; 68: 905–21
Holubarsch C, Hasenfuss G, Schmidt-Schweda S, et al. Angiotensin I and II exert inotropic effects in atrial but not in ventricular human myocardium: an in vitro study under physiological experimental conditions. Circulation 1993; 88(3): 1228–37
Schelling P, Ganten D, Speck G, et al. Effects of angiotensin II and angiotensin II antagonist saralasin on cell growth and renin in 3T3 and SV 3T3 cells. J Cell Physiol 1979; 98: 503–13
Kaplan NM. New perspectives in the treatment of hypertension with arterial disease. J Cardiovasc Pharmacol 1985; 7: 5131–4
Naftilan AJ, Pratt RE, Eldridge CS, et al. Angiotensin II induces c-fos expression in smooth muscle via transcriptional control. Hypertension 1989; 13:706–11
Cohn JN, Johnson G, Ziesche S, et al. A comparison of enalapril with hydralazine/isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 1991; 325: 303–10
Richards AM, Nicholls MG, Crozier JG. Role of ACE inhibitors in hypertension with left ventricular hypertrophy. Br Heart J 1994; 72 Suppl.: 24–32
Svanborg A. Blood pressure changes with aging: the search for normality. In: Cuervo CA, Robinson BE, Sheppard HL, editors. Geriatric hypertension. Tampa (FL): The International Exchange Center on Gerontology 1989: 5–17
Svanborg A. Postponement of aging. In: Birren JE, editor. Encyclopedia of gerontology. Vol. II. New York: Academic Press 1996: 333–40
Svanborg A. Cardiovascular system. In: Birren JE, editor. Encyclopedia of gerontology. Vol. I. New York: Academic Press 1996; 245–51
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Svanborg, A. Age-Related Changes in Cardiac Physiology. Drugs & Aging 10, 463–472 (1997). https://doi.org/10.2165/00002512-199710060-00006
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DOI: https://doi.org/10.2165/00002512-199710060-00006