Aging changes in Cardiovascular System

The cardiovascular system is the body’s main transport system, and its efficiency is essential for
health and longevity. As its ages, it becomes less efficient, which has a negative impact on all other
organ systems. The cardiovascular system is the body’s main transport system. Its most important
role is to deliver oxygenated blood, nutrients, and chemical signals, such as hormones, to the organs
and tissues. It also transports carbon dioxide to the lungs and waste products, such as urea and uric
acid, to the kidneys for elimination. It plays a major role in thermoregulation – distributing and
dissipating heat throughout the body (Marie and Hoehn, 2015). An efficient cardiovascular system is
essential for health and longevity, but its efficiency reduces with age, which has a negative impact on
all other organ systems.

Structural Changes

Structural changes with aging involve the myocardium, the cardiac conduction system, and the
endocardium. There is a progressive degeneration of the cardiac structures with aging, including a
loss of elasticity, fibrotic changes in the valves of the heart, and infiltration with amyloid. The age-
associated structural characteristics that have the greatest impact involve the contractility of the
heart's left ventricular wall. The pumping capacity of the heart is reduced with age due to a variety of
changes affecting the structure and function of the heart muscle.

Valves

An age-related increase in valvular circumference has been reported in all four cardiac valves
(aortic semilunar valve, semilunar valve, bicuspid valve, tricuspid valve),with the greatest
changes occurring in the aortic valve (the valve between the left ventricle and the aorta) Calcific
deposits frequently are present one or more aortic valve cusp. These changes do not usually cause
significant dysfunction, although in some older adults, severe aortic valvular stenosis and mitral
valvular insufficiency are related to degenerative changes with age. Clinical heart murmurs are
detected more frequently.

Myocardial Sub-cellular Changes

The nucleus, containing DNA, becomes larger and may show invagination of its membrane. The
mitochondria show alterations in size, shape, crystal pattern, and matrix density, which reduce
their functional surface. The cytoplasm is marked by fatty infiltration or degeneration, vacuole
formation, and a progressive accumulation of pigments such as lipofuscin. The combined age-
related changes in the sub-cellular compartments of the cells result in decreased cellular activities
such as altered homeostasis, protein synthesis, and degradation rates.

Cardiac Muscle Compliance

The decline in left ventricular compliance provides an increase workload on the atria, resulting in
hypertrophy of the atria.

Vascular changes
 We are born with arteries that are elastic, flexible, and compliant, allowing optimal cardiac
function and blood flow. During ventricular systole (contraction), blood is ejected into the
pulmonary and systemic circuits and the larger elastic arteries stretch, reducing the resistance to
blood flow. As the body ages, blood vessels, particularly arteries, lose their elasticity and the
arterial walls become stiffer and thicker. The larger arteries have a high elastin content as they
need to stretch in harmony with the powerful ventricular contractions of the heart to cushion the
force of the pulse wave, smoothing out the flow of blood entering the smaller arteries. These
events cumulatively result in a gradual loss of elasticity and stiffening of the arteries, which is
often reflected by increased blood pressure (Bolton and Rajkumar, 2011).

Endothelial

The most delicate part of a blood vessel is in direct contact with the circulating blood (Marieb
and Hoehn, 2015). As its ages, the endothelium develops irregularly shaped cells and is often
thickened due to the presence of smooth muscle fibers that have migrated from the tunica
media. This thickening contributes to a reduction in arterial elasticity and compliance, and
reduces the lumen size (Fig 1), further increasing resistance to blood flow.

Cardiac changes

To overcome reduced elasticity and increased resistance to blood flow of aged and occluded
arteries, the heart’s ventricles must pump with greater force. The myocardium (muscular layer of
the heart) responds by becoming hypertrophied. Earlier ultrasound studies suggested the
thickness of the left ventricle increases by around 30% between the ages of 20 and 80 years, with
an associated gradual increase in cardiac weight (Pearson et al, 1991).
The number of cardiac myocytes (muscle cells) in the myocardium decreases progressively
through apoptosis (programmed cell death); the remaining myocytes undergo morphological
changes, often becoming enlarged (cellular hypertrophy) or irregular in shape. The amount of
collagen deposited in the myocardium also increases with age. Together with the redistribution of
cardiac muscle mass, this typically results in an observable change in the shape of the heart from
the classic elliptical shape to a slightly more spherical appearance (Strait and Lakatta, 2012;
Ferrari et al, 2003).

Cardiac function

 The changes to both the vasculature and the heart itself lead to a general reduction in
the efficiency of the heart. The resting heart rate when a person is lying flat remains constant
as we age but, in a sitting position, this generally decreases (Bolton and Rajkumar, 2011).

 One of the most striking age-related changes in cardiac function is a linear decrease in
the maximal heart rate achievable during exercise. In old age, this fall, roughly in line with
the formula ‘220 minus age in years’ so, by the age of 60, it is around 160bpm. It is thought
this reduction is primarily due to changes in the heart’s conductive system. The filling of the
ventricles also slows with age, as the increased collagen content in the ventricle walls leads
to slower ventricular relaxation (Strait and Lakatta, 2012).

Cardiac conductive system

 By the age of 50, the sinoatrial node (the heart’s natural pacemaker) has lost 50-75% of its
cells. While the number of cells in the atrioventricular node remains relatively constant,
there is fibrosis and cellular death in the atrioventricular bundle, also called the bundle of
His (heart muscle cells specialised in electrical conduction).
 These changes may reduce the efficiency of cardiac conduction and contribute to the decline
in maximal heart rate (Ferrari et al, 2003). The reduction in pacemaker cells makes atrial
and ventricular arrhythmias much more likely; an example of this is atrial fibrillation in
older people.

Blood Pressure

 The increase in blood pressure seen with aging is most likely related to arterial changes.
Aging results in narrowing of the vessel lumen and stiffening of the vessel walls through a
process known as atherosclerosis. Atherosclerosis leads to structural alterations including
increased vascular calcification causing earlier reflected pressure waves during blood
pressure wave propagation. The pressure wave arrives back from the aortic root during
systole and contributes to the increase in systolic blood pressure. Diastolic blood pressure
tends to increase up to the age of about 50 and the increase is due to the rise in arteriolar
resistance. The large artery stiffening that occurs later in life contributes a wider pulse
pressure including a decreased diastolic blood pressure. The increase in arteriolar resistance
along with large artery stiffening leads to a significant increase in systolic blood pressure,
pulse pressure and mean arterial pressure.

 The decreased ability to appropriately respond to abrupt hemodynamic changes is rooted in

many pathophysiological factors including a change in heart structure and function and a
decrease in the autonomic regulation of blood pressure. Left ventricular hypertrophy and a
 decrease in left ventricle compliance correlates with a reduction in cardiac performance and
in the ability to increase systolic blood pressure in response to stress. The autonomic system
plays a key role in the maintenance of blood pressure through physiologic responses to
standing, volume depletion, and increased cardiac output during stress. With a decrease in
the autonomic regulation of blood pressure, there is a significant impact on physiologic
adaption. One example includes the high prevalence of orthostatic hypotension among the
elderly population.

Reduced in baroreceptor response

In older people, baroreceptor reflexes are blunted, which often results in an increased
variability of blood pressure throughout the day and may reduce the ability to maintain blood
pressure after blood loss (Monahan, 2007). It is thought that age-related thickening of the
arterial walls may interfere with the ability of baroreceptors to accurately measure the degree
of stretch (blood pressure) within the vessel. This can increase the risk of postural
hypotension, increasing the risk of falls.
\

People age 65 and older are much more likely than younger people to suffer a heart attack, to have
a stroke, or to develop coronary heart disease (commonly called heart disease) and heart
failure. Heart disease is also a major cause of disability, limiting the activity and eroding the quality
of life of millions of older people.

Aging can cause changes in the heart and blood vessels. For example, as you get older, your heart
can't beat as fast during physical activity or times of stress as it did when you were younger.
However, the number of heart beats per minute (heart rate) at rest does not change significantly with
normal aging.

Changes that happen with age may increase a person's risk of heart disease. A major cause of heart
disease is the buildup of fatty deposits in the walls of arteries over many years. The good news is
there are things you can do to delay, lower, or possibly avoid or reverse your risk.
Glossary
Look up the definitions of unfamiliar heart health terms in the Heart Health Glossary.

The most common aging change is increased stiffness of the large arteries, called arteriosclerosis
(ahr-teer-ee-o-skluh-roh-sis), or hardening of the arteries. This causes high blood pressure, or
hypertension, which becomes more common as we age.

High blood pressure and other risk factors, including advancing age, increase the risk of developing
atherosclerosis (ath-uh-roh-skluh-roh-sis). Because there are several modifiable risk factors for
atherosclerosis, it is not necessarily a normal part of aging. Plaque builds up inside the walls of your
arteries and, over time, hardens and narrows your arteries, which limits the flow of oxygen-rich
blood to your organs and other parts of your body. Oxygen and blood nutrients are supplied to the
heart muscle through the coronary arteries. Heart disease develops when plaque builds up in the
coronary arteries, reducing blood flow to your heart muscle. Over time, the heart muscle can become
weakened and/or damaged, resulting in heart failure. Heart damage can be caused by heart attacks,
long-standing hypertension and diabetes, and chronic heavy alcohol use.
Check Your Blood Pressure

As you get older, it is important for you to have your blood pressure checked regularly, even if you
are healthy. This is because aging changes in your arteries can lead to hypertension. You may feel
fine but, if not treated, high blood pressure could lead to stroke and problems with your heart, eyes,
brain, and kidneys. To manage high blood pressure, exercise, dietary changes, and reducing your salt
intake can help, but as aging changes in the arteries often cause high blood pressure in older age,
medication is often necessary. It is not uncommon to need more than one medication to control your
blood pressure.

Age can cause other changes to the heart. For example:

  There are age-related changes in the electrical system that can lead to arrhythmias—a rapid,
slowed, or irregular heartbeat—and/or the need for a pacemaker. Valves—the one-way, door-
like parts that open and close to control blood flow between the chambers of your heart—
may become thicker and stiffer. Stiffer valves can limit the flow of blood out of the heart and
become leaky, both of which can cause fluid to build up in the lungs or in the body (legs, feet,
and abdomen).
 The chambers of your heart may increase in size. The heart wall thickens, so the amount of
blood that a chamber can hold may decrease despite the increased overall heart size. The
heart may fill more slowly. Long-standing hypertension is the main cause of increased
thickness of the heart wall, which can increase the risk of atrial fibrillation, a common heart
rhythm problem in older people.
 With increasing age, people become more sensitive to salt, which may cause an increase in
blood pressure and/or ankle or foot swelling (edema).

Other factors, such as thyroid disease or chemotherapy, may also weaken the heart muscle. Things
you can't control, like your family history, might increase your risk of heart disease. But leading a
heart-healthy lifestyle might help you avoid or delay serious illness.

Reference:

https://www.nia.nih.gov/health/heart-health-and-aging?
fbclid=IwAR2i4L9UBdf_6aA54MhsSMvFgJBgXhqetAUSu9OOdKfZBNZhXcHwU6lEu0c

https://www.ncbi.nlm.nih.gov/books/NBK537297/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805932/

https://www.medscape.com/viewarticle/450564

https://www.nursingtimes.net/roles/older-people-nurses-roles/anatomy-and-physiology-of-ageing-1-
the-cardiovascular-system-31-01-2017/