Lecture 7: Cardiovascular aging
‘A man is as old as his arteries’
Learning objectives:
- The student can explain why age contributes to cardiovascular disease
- The student can explain the basic (patho)physiology of cardiovascular aging
- The student can describe symptoms of cardiovascular aging
- The student can explain the applications of different measurements such as cIMT and pulse
wave velocity in cardiovascular aging
y-as is incidence
x- as the age
Increasing age, the number of disease rise.
You see that male have more myocardial infarctions than female, because they smoke more. It is a
systemic disease, if you have a myocardial infarction, the chance that you will have a heart failure,
will increase as well.
When people get older, they have more cardiovascular diseases. People get older, so they also have
more kinds of cardiovascular diseases.
Two mechanisms are very important, atherosclerosis and arterial stiffening. These both rise the
chance on getting a heart failure, but also renal failure, peripheral arterial disease and vascular
dementia.
The picture below also shows that until 2005 men had more often cardiovascular disease than
women. This is due to the fact that the lifestyle of men and women are more similar.
Natural and protected environments:
- Protected environment = climate control, biomedical interventions.
- Natural environment = hazard, predators, infection etc.
,People get older, so they also get more diseases. The picture shows that due to protected
environment, we live around 30 years longer compared to when we only have the natural
environment. This is also what the history shows.
Between 1950 and 2020:
In the 50s we had to practice a lot before you succeed.
After we got the expertise, we became good in procedures and interventions for cardiovascular
disease. One of the most important interventions were the findings of risk factors, such as the role of
cholesterol.
In the 70s, the number of people dying from cardiovascular diseases decreased.
Cardiovascular disease and multimorbidity:
Most people older than 60 have more diseases. F.e. hypertension, diabetes, fatty liver disease, early
dementia etc. about 80% of the people above 60 have 3 or more chronic diseases.
You have to be broad educated to treat the patients with multimorbidity properly.
f.e. when you have dementia, most people will forget their drugs and this will increase the risk for a
heart failure.
➔ a physian needs a college/internist who can combine these different diseases.
Evaluation of cardiovascular risk in the elderly:
See quote (important): it should be the function of medicine to have die people young as late as
possible. This is complicated.
Heart failure and frailty:
NYHA classification shows the severity of heart failure.
You look at the number of persons who have adverse health outcomes, people with less severe heart
failure, have less adverse health outcomes. Persons who are most frail, have the most adverse health
outcomes. And when you see that more domains are affected by the heart failure, the person will
have more adverse health outcomes.
,The number of domains is important to say something about the prognosis.
When someone has 3 or more domains which are affected, you should think not only about treating,
but also about where the person wants to die etc. because healing is not always possible in that case.
Two important function of the arterial tree:
1. To deliver oxygen from the heart to end-organs (this can be impaired due to atherosclerosis)
2. To cushion the pulsations generated from the heart into a continuous flow in the capillary
system (arterial stiffening)
Heart → aorta → large artery → small artery → arteriole → capillaries → venule → vein → vena
cava → heart
, Notice that the pressure in the arterioles is much higher than in the capillaries.
Blood vessel has 3 layers:
Intima media → when you get athrosclerosis, the intima is damaged, than you get cholesterol
between the intima and the media. You get a plaque, when this progresses, the tissue behind the
plaque won’t get oxygen anymore. This is one of the reasons to get a heart attack.
Intact endothelium: acts as a vasolidatator, anticoagulant, fibrinolytic and anti-inflammatory.
Lesion endothelium: vasoconstriction, pro-coagulant, anti-fibrinolitic and pro-inflammatory.
Media
Exer tisia
Plaque formation:
In a normal blood vessel, there is a balance in the layers. A fatty streak can happen, this will lead to
the formation of a plague. This plaque is able to grow and increase, the tissue behind the plaque will
not get oxygen anymore. When the plaque is big enough, it can form an obstruction in the blood
vessel. It is now called an atherosclerotic plaque. The plaque fissure or erosion results in thrombosis
and this may lead to an unstable angina, acute myocardial infarction or even death from coronary
disease.
‘A man is as old as his arteries’
Learning objectives:
- The student can explain why age contributes to cardiovascular disease
- The student can explain the basic (patho)physiology of cardiovascular aging
- The student can describe symptoms of cardiovascular aging
- The student can explain the applications of different measurements such as cIMT and pulse
wave velocity in cardiovascular aging
y-as is incidence
x- as the age
Increasing age, the number of disease rise.
You see that male have more myocardial infarctions than female, because they smoke more. It is a
systemic disease, if you have a myocardial infarction, the chance that you will have a heart failure,
will increase as well.
When people get older, they have more cardiovascular diseases. People get older, so they also have
more kinds of cardiovascular diseases.
Two mechanisms are very important, atherosclerosis and arterial stiffening. These both rise the
chance on getting a heart failure, but also renal failure, peripheral arterial disease and vascular
dementia.
The picture below also shows that until 2005 men had more often cardiovascular disease than
women. This is due to the fact that the lifestyle of men and women are more similar.
Natural and protected environments:
- Protected environment = climate control, biomedical interventions.
- Natural environment = hazard, predators, infection etc.
,People get older, so they also get more diseases. The picture shows that due to protected
environment, we live around 30 years longer compared to when we only have the natural
environment. This is also what the history shows.
Between 1950 and 2020:
In the 50s we had to practice a lot before you succeed.
After we got the expertise, we became good in procedures and interventions for cardiovascular
disease. One of the most important interventions were the findings of risk factors, such as the role of
cholesterol.
In the 70s, the number of people dying from cardiovascular diseases decreased.
Cardiovascular disease and multimorbidity:
Most people older than 60 have more diseases. F.e. hypertension, diabetes, fatty liver disease, early
dementia etc. about 80% of the people above 60 have 3 or more chronic diseases.
You have to be broad educated to treat the patients with multimorbidity properly.
f.e. when you have dementia, most people will forget their drugs and this will increase the risk for a
heart failure.
➔ a physian needs a college/internist who can combine these different diseases.
Evaluation of cardiovascular risk in the elderly:
See quote (important): it should be the function of medicine to have die people young as late as
possible. This is complicated.
Heart failure and frailty:
NYHA classification shows the severity of heart failure.
You look at the number of persons who have adverse health outcomes, people with less severe heart
failure, have less adverse health outcomes. Persons who are most frail, have the most adverse health
outcomes. And when you see that more domains are affected by the heart failure, the person will
have more adverse health outcomes.
,The number of domains is important to say something about the prognosis.
When someone has 3 or more domains which are affected, you should think not only about treating,
but also about where the person wants to die etc. because healing is not always possible in that case.
Two important function of the arterial tree:
1. To deliver oxygen from the heart to end-organs (this can be impaired due to atherosclerosis)
2. To cushion the pulsations generated from the heart into a continuous flow in the capillary
system (arterial stiffening)
Heart → aorta → large artery → small artery → arteriole → capillaries → venule → vein → vena
cava → heart
, Notice that the pressure in the arterioles is much higher than in the capillaries.
Blood vessel has 3 layers:
Intima media → when you get athrosclerosis, the intima is damaged, than you get cholesterol
between the intima and the media. You get a plaque, when this progresses, the tissue behind the
plaque won’t get oxygen anymore. This is one of the reasons to get a heart attack.
Intact endothelium: acts as a vasolidatator, anticoagulant, fibrinolytic and anti-inflammatory.
Lesion endothelium: vasoconstriction, pro-coagulant, anti-fibrinolitic and pro-inflammatory.
Media
Exer tisia
Plaque formation:
In a normal blood vessel, there is a balance in the layers. A fatty streak can happen, this will lead to
the formation of a plague. This plaque is able to grow and increase, the tissue behind the plaque will
not get oxygen anymore. When the plaque is big enough, it can form an obstruction in the blood
vessel. It is now called an atherosclerotic plaque. The plaque fissure or erosion results in thrombosis
and this may lead to an unstable angina, acute myocardial infarction or even death from coronary
disease.
