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Aging and pain perception in ischemic heart disease
P F Miller1, D S Sheps, E E Bragdon
1Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill 27599.
Insights
Older adults experience less chest pain during heart ischemia, increasing the risk of silent myocardial ischemia. This study found age independently linked to reduced pain perception in coronary artery disease patients.
Area of Science:
- Cardiology
- Gerontology
- Clinical Medicine
Background:
- Age is a known risk factor for coronary artery disease (CAD).
- The connection between aging and silent myocardial ischemia remains unclear.
- Silent ischemia, lacking typical angina symptoms, poses diagnostic challenges.
Purpose of the Study:
- To investigate the relationship between patient age and the perception of ischemic cardiac pain.
- To determine if age is an independent factor influencing silent myocardial ischemia.
Main Methods:
- Analysis of 35 radionuclide ventriculography studies in patients with documented ischemic CAD.
- Calculation of the pain perception index (PPI) based on ST depression and angina onset times during exercise.
- Statistical correlation analysis between PPI, age, medication, and disease severity.
Main Results:
- A significant positive correlation was found between age and PPI (r = 0.37, p = 0.03).
- Older age was associated with a muted perception of ischemic cardiac pain.
- This association persisted even after controlling for medication and disease severity.
Conclusions:
- Increasing age is an independent risk factor for diminished perception of ischemic cardiac pain.
- This reduced pain perception may contribute to a higher prevalence of silent myocardial ischemia in older individuals.
- Age-related changes in pain signaling warrant further investigation in cardiovascular disease.
Abstract:
Age is a recognized risk factor for coronary artery disease, but the relationship between age and silent ischemia is not well understood. We analyzed the data from 35 rest/stress radionuclide ventriculography examinations in patients with documented ischemic coronary artery disease who had experienced 1 mm ST segment depression accompanied by angina during exercise testing. An index of ischemic cardiac pain perception (PPI) was calculated by subtracting the time of onset of 1 mm ST segment depression from the time of onset of angina. The mean value of PPI was -97 +/- 311 seconds. PPI was significantly correlated with age (r = 0.37, p = 0.03). This suggests that as age increases, perception of pain during myocardial ischemic episodes becomes muted. This relationship remained significant when we controlled for the presence of medication and severity of disease (change in ejection fraction from rest to peak exercise). These findings suggest that age is an independent risk factor for a decreased perception of ischemic cardiac pain, and thus for silent myocardial ischemia.