Cardiovascular Aging Continuing Medical Implementation bridging the care

Cardiovascular Aging © Continuing Medical Implementation ® …. . . bridging the care gap

Cardiovascular Aging 1 • Resting LV systolic function normal in absence of CAD, Hypertension • SBP and pulse pressure increase with age • Sedentary lifestyle may impact on CV system and obscure impact of aging changes • Lifestyle alterations may delay and partially reverse changes of cardiovascular aging – MVO 2, peak exercise EF, CI, SVI; ESVI © Continuing Medical Implementation ® …. . . bridging the care gap

Cardiovascular Aging 2 • Increased systemic vascular impedence – Systolic hypertension – LV hypertrophy • Impaired ventricular diastolic relaxation and compliance – – – Increased cardiac interstitial collagen Compensatory myocyte hypertrophy Impaired calcium flux during diastole Increased LVEDP, LA size Predispose to atrial fibrillation © Continuing Medical Implementation ® …. . . bridging the care gap

Cardiovascular Aging 3 • Diminished responsiveness to betaadreneric stimulation – Reductions in maximum HR • 1 & 2 effect – Impaired peripheral vasodilatation • 2 effect • Altered myocardial energy metabolism – Impaired mitochondrial capacity to increase ATP © Continuing Medical Implementation ® …. . . bridging the care gap

Cardiovascular Aging 4 Clinical implications • Increased preload and afterload • Impaired augmentation of cardiac output – Physiologic stress (exercise) – Pathologic stress (e. g. MI, infection, surgery) • CO = HR X SV (preload and afterload) © Continuing Medical Implementation ® …. . . bridging the care gap

Cardiovascular Aging 5 • Echocardiography – LV wall thickness and mass increase linearly with age – LVEF correlates strongly with presence of CAD and HTN • EBCT – Increased coronary and aortic calcification – Correlate with pulse pressure, low HDL, LDL, BS, smoking & obesity © Continuing Medical Implementation ® …. . . bridging the care gap

CV Disease and the Elderly • CV disease rises sharply with age • 85% of CHD deaths are in patients > 65 years of age • 60 % of admissions for acute MI are in patients > 65 years of age • In the US about 35 million people will be > 65 by 2000 • The subset > 85 is growing the fastest – 2/3 of this elderly population is female © Continuing Medical Implementation ® …. . . bridging the care gap

Age as a Risk Factor: 12 -year Incidence Rates for CAD Age, years Men Women 30 -39 5% 1% 40 -49 11% 5% 50 -59 20% 12% 60 -69 29% 15% 70 -74 26% 20% Source: Framingham Heart Study. Am J Hypertens 1993; 6: 309 S-313 S © Continuing Medical Implementation ® …. . . bridging the care gap

Traditional medical approaches do not cater for the heterogeneity of disease in the elderly! © Continuing Medical Implementation ® …. . . bridging the care gap

Spectrum of CV Disease in the Elderly • Arrhythmias – atrial fibrillation – ventricular • Atherosclerotic vascular disease – cerebrovascular disease – peripheral vascular disease • CAD – chronic stable angina – acute ischaemic syndromes • Conducting System Disease © Continuing Medical Implementation ® • Congestive Heart Failure - Systolic - Diastolic • Hyperlipidemia • Hypertension • Hypertrophic cardiomyopathy • Valvular Heart Disease – Aortic sclerosis – Aortic stenosis – Mitral annular calcification …. . . bridging the care gap