The continuing saga of aging and heart failure

Abstract

As the American pop singers Sonny and Cher put it, ‘‘the beat goes on...’’ The first special symposium issue of Heart Failure Reviews on Aging and Heart Failure (HF) was published in September 2010. It drew attention to the arbitrary chronological definition of the elderly and the importance of the changing demographics with respect to the growing population of elderly people with major aging-related cardiovascular (CV) diseases that lead to HF, such as hypertension and myocardial infarction [1]. In that issue, a group of clinicianscientists discussed pertinent aspects of epidemiology and management of elderly patients with STEMI and HF [2, 3]. Other expert clinician-scientists addressed, in the context of aging and HF, the role of inflammatory implications and fibrogenic pathways [4], autophagy [5], sarcoplasmic reticulum calcium signaling [6], stem cells [7], adiponectin [8], resveratrol and longevity [9], telomeres [10], osteopontin [11] and beta-adrenergic signaling [12]. As guest editor of the first issue, I emphasized the importance of understanding the biology of cardiovascular aging and its impact on the pathophysiology of HF. I pointed out that recognizing that the aging process is associated with physiological as well as biochemical, molecular, cellular and extracellular changes is critical for development and discovery of novel targets and therapies pertinent to that growing segment of the population. In September 2010, I had the opportunity to drive those points home at a lecture on ‘‘The biology of aging in the cardiac patient’’ for a new symposium on ‘‘Biology of Aging and HF Management’’ during the 14th Annual scientific meeting of the HF Society of North America in San Diego. In October 2011, the chair person of my session asked me whether we should define elderly as age C65 years after a talk dealing with chronological versus biological aging and HF in the elderly, indicating the continuing need for increased awareness. At the 20th Annual Meeting of the American Heart Association in Orlando, November 2011, it was gratifying to see that a last day afternoon session (2–5 pm) entitled ‘‘Aging, death and CV homeostasis’’ should attract an audience of predominantly young researchers. HF remains an important problem in the elderly in North America, Europe and other developed countries. Improved medicine, public health, Medicare and socioeconomic conditions in Western countries have extended life span. However, this increased longevity is sadly associated with a parallel increase in morbidity due to HF. There is an increasing need for development and discovery of novel targets and therapies pertinent to the growing elderly population in order to ensure that they enjoy the extended life span and continue to contribute meaningfully to society if they so choose. Since the changes with aging are progressive and a host of risk factors damage the CV system during aging, improving the lot of the older, elderly and oldest elderly segments depends to some extent on the success of preventative measures in the young, beginning in early childhood. The beat must go on. This second Symposium issue of Heart Failure Reviews includes a series of 15 review articles focused on aging-related issues pertinent to HF in the elderly. The first twelve papers deal with clinical issues. In the lead article, I address HF prevention strategies in the context of the aging continuum and chronological versus biological aging, and discuss promotion of healthy aging through education on CV risk factors and prevention through aggressive CV risk management. Jerome Fleg addresses the role of aging-related changes in CV structure B. I. Jugdutt (&) Department of Medicine, Division of Cardiology, University of Alberta and Hospitals, 2C2 Walter MacKenzie Health Sciences Centre, Edmonton, AB T6G 2R7, Canada e-mail: bjugdutt@ualberta.ca