Heart Aging

Epidemiological studies have determined that age, per se, is the major risk for coronary artery disease, hypertension, and resultant chronic heart failure, which are the major diseases that affect our society. One interpretation of the marked effect of advancing age on the occurrence of these diseases is that aging is synonymous with these disease processes; another is that other defined risk factors for these diseases, eg, hypertension or diabetes, vary in number or severity with increasing age. Still another viewpoint posits that increasing age is the equivalent of an increased time at risk. A contrasting view is that cardiovascular structure and function change with time because of an aging process that alters the substrate on which pathophysiologic mechanisms interact.1 According to this view, age-associated changes become partners with these disease mechanisms to determine the threshold for clinical signs and symptoms, severity, and prognosis of cardiovascular diseases in older persons. In this regard, the enhanced risk for older persons is attributable to an interaction between age and time-of-disease presence. Researchers of heart disease mechanisms must “fess up” to the recognition of the reality of these age-disease interactions. In reality, interactions are more complex and involve age, disease, lifestyle (including environment), and the genetic components of each of these. We have begun to understand some aspects of the former three, but the latter likely involves complex genetic traits that by and large presently remain elusive.Quantitative information on cardiovascular structure and function in health to define specific phenotypic characteristics or biomarkers of cardiovascular aging is necessary for an in-depth analysis of genetic contributions to aging and disease. During the last three decades, a sustained effort has been applied to characterize the effects of aging on multiple aspects of cardiovascular structure and function in study populations, such as the Baltimore Longitudinal Study …