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

2. © 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

3. © 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

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

5. © 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)

6. © 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

7. © 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

8. © Continuing Medical Implementation ® …...bridging the care gap Age as a Risk Factor: 12-year Incidence Rates for CAD Age, yearsMenWomen 30-395%1% 40-4911%5% 50-5920%12% 60-6929%15% 70-7426%20% Source: Framingham Heart Study. Am J Hypertens 1993;6:309S-313S

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

10. © 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 Congestive Heart Failure  Systolic  Diastolic Hyperlipidemia Hypertension Hypertrophic cardiomyopathy Valvular Heart Disease –Aortic sclerosis –Aortic stenosis –Mitral annular calcification