Atherosclerotic disease in octogenarians: a challenge for science and clinical practice

Besides the time of exposure to the traditional risk factors, new players take the lead in the modulation of atherogenesis in the very elderly, promoting a step increase in the incidence of cardiovascular events. Accordingly, atherosclerotic plaques become more abundant and portray more unstable features, such as increased inflammatory activity and reduction of smooth muscle cells in the very elderly. This new scenario is composed of new potential modulators of atherogenesis such as cellular senescence, immunosenescence, frailty syndrome, sarcopenia and sirtuins, and changes among the traditional cardiovascular risk factors which gain new attributes and new magnitudes of interaction with atherosclerotic disease. Consistent with this concept, mortality from atherosclerotic disease has shown a decrease in individuals younger than 60 years, but no change in incidence in individuals over the age of 60 years. In this review, we present the most recent and relevant pieces of evidence to the peculiarities of traditional cardiovascular risk factors and new aging-related potential modulators of atherosclerotic disease in very elderly.