Most cardiovascular disease (CVD) occurs in patients over the age of 60. However, most evidence-based current cardiovascular guidelines lack evidence in an older population, due to the under-representation of older patients in randomised trials. Blood pressure rises with age due to increasing arterial stiffness, and stricter control results in improved outcomes. Myocardial ischaemia is also more common with increasing age, due to a combination of coronary artery disease and myocardial changes. However, despite higher rates of adverse outcomes, older patients are offered guideline-based therapy less frequently. Frailty is an independent predictor of mortality in adults over the age of 60, yet remains poorly assessed; slow gait speed is a key marker for the development of frailty and for adverse outcomes following intervention. Few trials have assessed frailty independent of age; however, there is evidence that non-frail older patients derive significant benefit from therapy, highlighting the urgent need to include frailty as a measure in clinical trials of treatment in CVD.
In this review, the authors appraise the literature in regard to the cardiovascular changes with ageing, specifically in relation to the systemic and coronary circulation and with a particular emphasis on frailty and its implication in the evaluation and treatment of CVD.
- heart disease
- cardiac risk factors and prevention
- cardiac procedures and therapy
- myocardial disease basic science
- global disease patterns
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Contributors The paper was conceived by SN and DMK. The first draft was prepared by SN, with critical revision by both THM and DMK. All authors reviewed and significantly contributed to the content of the paper.
Funding SN is supported by a Health Professional Scholarship from the Heart Foundation of Australia (101116). DMK is supported by the National Health and Medical Research Council of Australia.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.