Pathophysiology of acute coronary syndromes in the elderly
Lina Badimon1, Raffaele Bugiardini2, Judit Cubedo3
1Cardiovascular Research Center (CSIC-ICCC) and Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain; Cardiovascular Research Chair UAB, Barcelona, Spain.
Insights
Elderly patients face higher risks for acute coronary syndrome (ACS) due to physiological aging. Individual risk assessment is crucial, as chronological age doesn't always reflect biological age, impacting treatment.
Area of Science:
- Cardiology
- Gerontology
- Internal Medicine
Background:
- Elderly patients constitute a significant and growing segment of the acute coronary syndrome (ACS) population.
- Aging involves physiological changes impacting cardiovascular risk, with a notable difference between chronological and biological age.
- Underrepresentation of older adults in clinical trials leads to suboptimal use of evidence-based treatments.
Purpose of the Study:
- To explore the pathophysiological mechanisms of age-related cardiovascular changes.
- To explain the increased risk and poorer prognosis of ACS in elderly individuals.
- To highlight the need for individualized risk assessment in this demographic.
Main Methods:
- Review of pathophysiological mechanisms of aging at vascular and cardiac levels.
- Analysis of factors contributing to high ACS prevalence and worse prognosis in the elderly.
- Discussion of discrepancies between chronological and biological age in risk assessment.
Main Results:
- Aging significantly alters vascular and cardiac function, increasing ACS susceptibility.
- Elderly ACS patients exhibit a worse prognosis compared to younger counterparts.
- Individualized risk assessment is essential due to variability in biological aging.
Conclusions:
- Age-related pathophysiological changes predispose elderly individuals to higher ACS risk and poorer outcomes.
- Addressing the gap in clinical trial representation and implementing personalized risk assessment are critical.
- Understanding biological aging is key to improving ACS management in the elderly.
Abstract:
Elderly patients represent an important proportion of the acute coronary syndrome (ACS) population. Furthermore, this group of ACS patients is continuously growing because of the progressive ageing of the population. The ageing process implies marked changes in patient physiology that directly impact in their risk. However, there is a differential distribution in the risk of elderly patients, revealing the existence of a discrepancy between the chronological and the "biological age". This discrepancy has highlighted the need of performing individual risk assessment in order to identify those patients at higher risk. In addition, the lack of representation of elderly patients in clinical trials leads to the underutilization of evidence-based therapies in this group of patients. All these factors influence not only the high prevalence of ACS presentation in the elderly but also their worse prognosis after suffering an ischaemic event. Herein we will explore the pathophysiological mechanisms behind the age-related changes at the vascular and the cardiac level that explain the high risk of elderly subjects of suffering ACS and their worse prognosis.
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