Ageing of the heart

Ageing of the heart is associated with a number of characteristic morphological, histological and biochemical changes. However, not all observed changes with age are associated with a deterioration in function. The high prevalence of hypertension and ischaemic heart disease makes distinction between normal ageing changes and the effects of underlying cardiovascular disease processes difficult. In this review, an attempt has been made to separate age-related changes from those related to disease, and to outline their significance for cardiac performance. Disease-independent changes in the ageing heart which are associated with a reduction in function include a reduction in the number of myocytes and cells within the specialised conduction tissue, the development of cardiac fibrosis, a reduction in calcium transport across membranes, lower capillary density and decreases in the intracellular response to beta-adrenergic stimulation. Other characteristic changes, such as epicardial fat deposition and 'brown atrophy' due to intracellular lipofuscin deposits, appear to be merely symptomatic of the ageing process without any obvious effects on function. Some of the age-associated changes in the heart can be reversed, at least partially, by exercise or specific drugs. It remains, however, unclear whether this would result in any definite advantages for the individual. The mechanisms guiding proliferation or non-proliferation of myocytes and the development of fibrosis are current topics for research and may lead to new preventive approaches to ageing processes in the heart.