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Cardiac Senescence, Heart Failure, and Frailty: A Triangle in Elderly People
1Department of General Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Insights
Aging increases cardiovascular disease (CVD) and heart failure (HF) risk in older adults. Cellular senescence and frailty, characterized by inflammation, contribute to poor outcomes and highlight the need for geriatric-focused treatments.
Area of Science:
- Geriatrics
- Cardiology
- Cellular Biology
- Aging Research
Background:
- Cardiovascular disease (CVD) and heart failure (HF) disproportionately affect the elderly, with outcomes worsening due to cardiac aging.
- Frailty, a syndrome of decreased physiological reserves and increased vulnerability, is an independent risk factor for incident HF in older adults.
- Cellular senescence, marked by a senescence-associated secretory phenotype (SASP), may drive inflammation, linking senescence to age-related CVD and frailty.
Purpose of the Study:
- To explore the role of cardiac aging and frailty in the prognosis of elderly patients with heart failure.
- To investigate the mechanisms by which cellular senescence and SASP contribute to age-related CVD and frailty.
- To emphasize the importance of geriatric conditions and potentially reversible frailty in managing elderly HF patients.
Main Methods:
- Review of current evidence on cardiac aging, frailty, and cellular senescence in cardiovascular disease.
- Analysis of the relationship between functional evaluation, frailty, and mortality in heart failure patients.
- Exploration of the pathobiology of frailty and potential therapeutic targets.
Main Results:
- Older age and cardiac aging are associated with increased morbidity and mortality in heart failure.
- Frailty is a significant independent predictor of incident heart failure and poorer prognosis in patients with CVD.
- SASP from senescent cells is implicated as a key factor in the development of age-related CVD and frailty.
Conclusions:
- Geriatric conditions, particularly frailty, must be considered in the management of elderly patients with heart failure.
- Understanding the role of cellular senescence and SASP is crucial for developing novel therapeutics for age-related CVD and frailty.
- Frailty is a dynamic state, offering opportunities for intervention and improved outcomes in an aging global population.
Abstract:
Cardiovascular disease (CVD) is a common problem in the elderly. In particular, the morbidity and mortality of patients with heart failure (HF) increase with age. The poor outcomes of elderly patients with HF can be explained partly by cardiac aging at the cellular and organ levels. Moreover, recent evidence has demonstrated that functional evaluation, which may reflect the status of individual aging, predicts mortality in patients with HF. Age-related changes occur throughout the body and in virtually all organ systems. Thus, we should pay more attention to geriatric conditions when treating patients with HF. Frailty represents a complex clinical syndrome that results from multiple impairments across different organs and is characterized by decreased physiological reserves and increased vulnerability to stressors. Frail patients with CVD have a worse prognosis than non-frail patients. Evidence demonstrates that frailty is an independent risk factor for incident HF among older people. The ways in which cellular senescence promotes age-related CVD and frailty remain an important issue in the biology of aging and clinical geriatrics. Senescent cells that have acquired a senescence-associated secretory phenotype (SASP) can cause local and potentially systemic inflammation. SASP might be a key phenomenon in the association between cellular senescence and the development of age-related CVD and frailty. Frailty is a dynamic and potentially reversible state; therefore, translational research efforts are focused on obtaining mechanistic insights into the pathobiology of frailty, the development of novel therapeutics, and the identification of biomarkers for frailty. This is particularly important in developed countries that are confronted with an aging society.
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