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Mechanisms Involved in Premature Aging in the Heart-Is There an Implication for Cardiac Surgery?
Bernd Niemann1, Andreas Simm2, Susanne Rohrbach3
1Department of Adult and Pediatric Cardiac and Vascular Surgery, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg (UKGM), Giessen, Germany.
Insights
As life expectancy increases, chronic diseases like cardiovascular diseases (CVD) rise. This review explores age-associated heart changes, focusing on obesity and potential myocardial rejuvenation therapies for better surgical outcomes.
Area of Science:
- Cardiology and Gerontology
- Focus on age-related cardiovascular changes and surgical implications.
Background:
- Global life expectancy has significantly increased, leading to a rise in chronic diseases, particularly cardiovascular diseases (CVD).
- CVD incidence is increasing in westernized societies and is projected to cause more deaths than infectious diseases globally by 2030.
- Age-associated cardiac changes are critical in cardiac surgery, with chronological age being an insufficient predictor of perioperative risk compared to frailty.
Purpose of the Study:
- To review age-associated myocardial changes relevant to cardiac surgery.
- To investigate the impact of mediators like obesity on myocardial aging.
- To discuss potential therapeutic strategies for myocardial rejuvenation in aged patients.
Main Methods:
- Literature review focusing on age-associated genetic, biochemical, and pathophysiological changes in the myocardium.
- Analysis of the correlation between CVD, biological age, and lifestyle factors.
- Exploration of therapeutic interventions for myocardial rejuvenation.
Main Results:
- Chronological age is a limited predictor of perioperative risk; frailty is a more potent indicator.
- Unhealthy lifestyles can accelerate vascular and myocardial aging.
- Understanding myocardial aging mechanisms can reveal therapeutic targets.
Conclusions:
- Therapeutic myocardial rejuvenation holds promise for stabilizing perioperative outcomes in elderly patients.
- Targeting mediators of myocardial aging, such as those related to obesity, is crucial.
- Further research into age-associated cardiac changes can improve surgical care for aging populations.
Abstract:
During the past century, life expectancy has risen in Germany from 35.6 and 38.5 years in men and women (1871/1881) to 78.2 and 83.1 years (2013/2015). In recent years, the dominance of chronic diseases as major contributors to total global mortality has emerged. The incidence of cardiovascular diseases (CVD) increases in westernized societies and projected trends suggest that by 2030, CVD alone will also be responsible for more deaths in low-income countries than infectious diseases. The occurrence of CVD also seems to correlate to a further increase of biological age within westernized societies. Therefore, age-associated changes in the heart are an issue of high interest in cardiac surgery. The chronological age is a prognostic marker in some clinical scoring systems. However, it does not represent an adequate estimation of the biological age of patients or their perioperative risk. In fact, frailty might be a more powerful predictor for normal perioperative course or risk escalation. An unhealthy, sedentary lifestyle can induce premature aging of vessels and myocardium. Understanding the age-associated genetic, biochemical, and pathophysiological changes can help identify the therapeutic capability of aged myocardium. Future "therapeutic myocardial rejuvenation" may represent a powerful tool for the stabilization of the perioperative course in aged patients. In this review, we will focus on selected mediators or conditions with impact on age-associated myocardial changes with a major focus on obesity and discuss potential therapeutic strategies to utilize or modify these mediators.
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