Ischemic Heart Disease

Abstract

Of all of the known risk factors for coronary artery disease, age remains the most potent. Yet, the specific processes that accompany increasing age and that render it such an important risk factor for cardiovascular disease are not clearly elucidated. Age-associated changes in cardiovascular structure and physiologic function alter the substrate on which disease is superimposed. (See Chapter 9 for a discussion on age-related cardiovascular changes) These alterations include increased central arterial stiffness, decreased responsiveness to β-adrenergic stimulation, delayed early left-ventricular diastolic filling, and endothelial dysfunction (1–3). Such changes impact the presentation, diagnosis, clinical manifestations, therapeutic management, and prognosis of cardiovascular disease. Although it is thought that these changes occur universally, the rate at which they change is highly variable. The resultant heterogeneity of the aging process adds further challenge to the clinical care of older patients because no clear markers exist to discern biologic from chronologic age.