Aging and Diseases of the Heart
2003; Lippincott Williams & Wilkins; Volume: 108; Issue: 14 Linguagem: Inglês
10.1161/01.cir.0000086898.96021.b9
ISSN1524-4539
AutoresShlomo Stern, Solomon Behar, Shmuel Gottlieb,
Tópico(s)Heart Rate Variability and Autonomic Control
ResumoHomeCirculationVol. 108, No. 14Aging and Diseases of the Heart Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBAging and Diseases of the Heart Shlomo Stern, MD, Solomon Behar, MD and Shmuel Gottlieb, MD Shlomo SternShlomo Stern From Bikur Cholim Hospital, Jerusalem (S.S., S.G.), and Neufeld Cardiac Research Institute, Tel-Hashomer (S.B., S.S.), Israel. , Solomon BeharSolomon Behar From Bikur Cholim Hospital, Jerusalem (S.S., S.G.), and Neufeld Cardiac Research Institute, Tel-Hashomer (S.B., S.S.), Israel. and Shmuel GottliebShmuel Gottlieb From Bikur Cholim Hospital, Jerusalem (S.S., S.G.), and Neufeld Cardiac Research Institute, Tel-Hashomer (S.B., S.S.), Israel. Originally published7 Oct 2003https://doi.org/10.1161/01.CIR.0000086898.96021.B9Circulation. 2003;108:e99–e101The different systems that serve our body and mind undergo alterations during the aging process as an unavoidable part of life. This process starts, according to some researchers, with birth and accelerates with advancing age, leading to changes that are sometimes obvious but frequently go unnoticed for a long time. One of the most widely discussed, investigated, diagnosed, and treated processes is atherosclerosis, which leads to unmistakable damage to our cardiovascular system.It is not in the scope of this article to delve into the question of whether this process is a natural part of aging or should be considered a disease. Whichever the case, with the aging of our population, we must deal more and more frequently with symptoms and signs of atherosclerosis and with the disease it causes, the ways we can avoid it or at least to slow the process, or, if detected at a late stage, how to treat it.Processes That Accompany AgingWith age, the function of the heart is influenced mainly by the decrease in elasticity and the ability to respond to changes in pressure (compliance) of the arterial system. The resultant increase in the resistance to the pumping action of the heart thereby increases the work needed to drive the blood to the various organs of the body.The atherosclerotic process results in thickening of the arterial wall, and this is relatively easily measured in our neck (carotid) arteries by the Doppler method, which involves a sonar or ultrasound image of the artery. The presence of such thickening may itself be a sign of preclinical disease and may even predict future cardiovascular disorders. The ensuing stiffening of the arteries leads to high blood pressure and, in the elderly especially, the upper (systolic) pressure increases, the lower (diastolic) pressure decreases, and the difference between the two, the pulse pressure, increases. This last effect is an independent risk factor for developing cardiovascular disorders. It is difficult to treat this type of hypertension, and only recently have there been indications that certain types of therapy that target the thickening of the arterial wall rather than aiming at lowering the pressure itself can be helpful. Among the drugs used to remodel the arterial wall, we find some old remedies, as well as newly discovered agents.The aforementioned increased load on the heart leads to an increase in the mass of the heart (hypertrophy) and to the formation of scar tissue in the heart muscle, thereby leading to impairment of the vital relaxation of the heartbeat. If the scarring affects the tiny organ (sinus node) that guards the regularity of the heart and/or the other minuscule node (the atrioventricular or AV node) that is essential for the propagation of the electrical impulse to the ventricles, major and sometimes fatal disturbances in heart rate and rhythm may occur.Formation of calcium crystals (calcification), which may be looked on as an extreme degree of fibrosis, affects mainly the heart valves, especially the aortic valve, which is located between the left ventricle and the aorta. This situation, which frequently can begin in people in their fifties, is often described, somewhat pejoratively, as senile aortic stenosis. Other cardiac valves may be involved as well, but the frequency of their involvement is far less. If calcification is detected in the coronary arteries, this may be a sign of atherosclerosis even in asymptomatic individuals.Symptoms That Should Lead to a Medical ConsultationElderly patients (those over the age of 70) should not neglect symptoms, such as shortness of breath, progressive fatigue, heartbeats that are too fast, too slow, or irregular, pain or discomfort in the left chest, or dizziness because all of these symptoms may not be a consequence of age alone but could signify a recently acquired heart condition.Angina PectorisPain in the left chest or more commonly "chest tightness" (angina pectoris), especially if elicited by physical or emotional stress, is a very frequent symptom in the elderly and becomes more frequent with advancing age. Paradoxically, angina pectoris without pain, also known as silent ischemia, becomes more frequent in older age (for more detailed information, see the Clinician Update by Stern. Angina pectoris without chest pain: clinical implications of silent ischemia. Circulation. 2001;106:1906–1908). Thus far, no explanation for this has been provided, but the phenomenon of silent or atypical presentation of chronic ischemic heart disease makes the diagnosis in the elderly more difficult. The two most frequently used diagnostic tools, the resting electrocardiogram [ECG] and exercise testing, also have limitations in the elderly, and therefore nuclear and echo testing with pharmacological agents are especially justified in this age group. The ultimate diagnostic test for angina pectoris is coronary arteriography, recommended frequently for octogenarians and occasionally even for nonagenarians (for more information on coronary arteriography, see the Cardiology Patient Page by Lange and Hillis. Diagnostic cardiac catheterization. Circulation. 2003; 107:e111–e113).Even in old age, revascularization therapies for angina pectoris, such as angioplasty or bypass surgery, seem to be superior to treatment with medicines with regard to improving quality of life and reducing angina severity without increasing cardiac mortality risk.Acute Coronary SyndromesHeart attack or acute symptoms that warn one of an impending heart attack are called acute coronary syndromes (ACS), and they become more frequent with advancing age. Even with a decrease in mortality from this disease over recent years, 85% of those who die from coronary heart disease are more than 65 years of age. Peculiarly, the characteristic expressions of ACS seen in younger persons (for example, angina pectoris at rest) are less typical and may even become nonexistent in the elderly. Moreover, the ECG, a relatively simple diagnostic tool that is the most widely used and which in younger persons shows typical alterations often yields fewer clues in elderly individuals. Thus, in the elderly, ACS may go unnoticed, unless the patient and the physician are aware of sudden shortness of breath, sudden fatigue, discomfort that may be confined to the abdomen more than to the chest, profound sweating, irregular heart beat, or even fainting (syncope); all of these symptoms alone or in combination may herald the development of ACS. With such alertness, the high rate of unrecognized heart attacks in the elderly may be significantly reduced.When a heart attack or ACS is diagnosed, drug therapies and/or immediate or early cardiac catheterization, ie, placing a catheter into the arteries that supply the heart muscle, injecting dye to visualize sites where the arteries are narrowed or occluded, and opening an occluded artery by balloon technique (angioplasty), have been shown to be as useful in the elderly, both in men and women, as they are in younger people.Heart FailureFatigue, shortness of breath, and swollen legs are the most common symptoms when the heart fails to perform its normal pumping function. The incidence of heart failure increases with age as the heart becomes more vulnerable to various injuries or simply begins to deteriorate as a pump as part of the aging process. The underlying causes of heart failure include impaired pumping function of the heart (contractility) caused by damage to the heart from decreased blood supply or a prior heart attack (systolic dysfunction), or an increase in pressure load or impaired relaxation (diastolic dysfunction, the ability of the heart to relax and fill passively with blood). In fact, with advancing age, the proportion of people with heart failure but normal systolic function approaches 50% or more. Diastolic dysfunction occurs more often in women than in men and also more often with hypertensive heart disease and diabetes. Even if well treated, heart failure leads more frequently to death in the elderly than in younger individuals.Irregular, Too Slow, or Too Fast HeartbeatsAlterations in the heartbeat are not necessarily perceived in the chest, but frequently patients experience them over the neck arteries, or may become aware of their presence because of sudden sweating, pallor, weakness, occasional dizziness, and/or fainting. Sometimes such disturbances may be present without any symptoms. The most frequent but usually not too serious arrhythmia is atrial fibrillation, which becomes more prevalent with advancing age. More serious arrhythmias are the ventricular arrhythmias that have marked predictive significance and are associated with increased mortality, especially if they occur after a heart attack. Twenty four-hour ambulatory ECG recording (Holter monitoring) is invaluable in detecting hidden arrhythmias even in asymptomatic patients, and it has been shown that the frequency and complexity of such arrhythmias increase with age and after a heart attack.Slow heartbeat, most commonly induced by a block in the electrical conduction system of the heart, is effectively treated by the implantation of a pacemaker, a procedure that is used without any age limit. The more sophisticated implantable heart device, the defibrillator, is also used frequently in the elderly with considerable benefit (for more information on defibrillators, see the Cardiology Patient Page by Reiffel and Dizon. The implantable cardioverter-defibrillator: patient perspective. Circulation. 2002;105:1022–1024).Recently developed drug therapies for the management of arrhythmias should be used in the elderly as well, but possible other illnesses in the aged (co-morbidities) that may affect the absorption, metabolism, and the excretion of the drug must be taken into consideration.Preventive Measures in Old AgeAdvice given to a young person aimed at prevention of atherosclerotic heart disease or its progression is valid for the elderly as well. Although aging itself is an independent risk factor for cardiovascular disease, we still advocate—irrespective of age—avoidance of smoking, promotion of physical activity, control of blood pressure, careful hypoglycemic therapy in diabetics, prevention of obesity, and all other measures that promote cardiac health. Surprisingly, statin therapy to reduce cholesterol has been shown to reduce mortality even if started over the age of 80 years, and in these individuals, lipid levels similar to those in younger persons are targeted.Aging and Diseases of the Heart: SummaryAlterations induced by advancing age:Alterations in the arteriesDecreased elasticityDecrease in complianceAtherosclerosisAlterations in the heartFibrosisIncrease in massCalcificationConsequences of age-induced alterations:Increased blood pressureAngina pectorisHeart attackHeart failureFrequent symptoms in old age:Shortness of breathFatiguePalpitationsChest pain or discomfortDizzinessIn old age:Typical angina is less frequentHeart attack may be silentECGs are less representativecontinuedMeasures of prevention:No smokingPhysical activityControl of blood pressureControl of diabetesMaintain healthy weightStatins to reduce cholesterolFootnotesCorrespondence to Shlomo Stern, MD, Bikur Cholim Hospital, PO Box 492, Jerusalem, 91004, Israel. E-mail [email protected]Additional Information1 Cheitlin MD, Zipes DP. Cardiovascular disease in the elderly. In: Braunwald E, Zipes DP, Libby P, eds. Heart Disease. A Text Book of Cardiovascular Medicine. 6th ed. Philadelphia, PA: WB Saunders; 2001:2019–2037.Google Scholar2 Tresch DD, Aronow WS, eds. Cardiovascular Disease in the Elderly Patients. New York, NY: Marcel Dekker; 1999.Google Scholar3 Wenger NK, ed. Cardiovascular Disease in the Octogenarian and Beyond. London, UK: Martin Dunitz, Ltd; 1999.Google Scholar4 Williams MA, Fleg JL, Ades PA, et al. Secondary prevention of coronary heart disease in the elderly (with emphasis on patients ≥75 years of age): an American Heart Association scientific statement from the Council on Clinical Cardiology Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention. Circulation. 2002; 105: 1735–1743.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Jia X, Sun C, Nambi V, Virani S, Taffet G, Boerwinkle E, Bressler J, Ndumele C, Windham B, de Lemos J, Matsushita K, McEvoy J, Hoogeveen R, Selvin E and Ballantyne C (2022) Midlife determinants of healthy cardiovascular aging: The Atherosclerosis Risk in Communities (ARIC) study, Atherosclerosis, 10.1016/j.atherosclerosis.2022.04.028, 350, (82-89), Online publication date: 1-Jun-2022. Guo J, Zhang Y, Liu T, Levy B, Libby P and Shi G (2022) Allergic asthma is a risk factor for human cardiovascular diseases, Nature Cardiovascular Research, 10.1038/s44161-022-00067-z, 1:5, (417-430), Online publication date: 1-May-2022. Fermini B and Bell D (2022) On the perspective of an aging population and its potential impact on drug attrition and pre-clinical cardiovascular safety assessment, Journal of Pharmacological and Toxicological Methods, 10.1016/j.vascn.2022.107184, (107184), Online publication date: 1-May-2022. Cheng Y, Hung Y and Hu W (2022) Polyphenols of Salvia miltiorrhiza in Aging-Associated Cardiovascular Diseases and Cancer Phenolic Compounds - Chemistry, Synthesis, Diversity, Non-Conventional Industrial, Pharmaceutical and Therapeutic Applications, 10.5772/intechopen.98632 Phyo A, Gonzalez-Chica D, Stocks N, Woods R, Tran T, Reid C, Tonkin A, Nelson M, McNeil J, Murray A, Gasevic D, Freak-Poli R and Ryan J (2022) Trajectories of physical health-related quality of life and the risk of incident cardiovascular disease events and all-cause mortality in older people, American Heart Journal Plus: Cardiology Research and Practice, 10.1016/j.ahjo.2022.100117, 13, (100117), Online publication date: 1-Jan-2022. Mohan H, Rao P, Kumara H and Manasa S (2021) Non-invasive technique for real-time myocardial infarction detection using faster R-CNN, Multimedia Tools and Applications, 10.1007/s11042-021-10957-2, 80:17, (26939-26967), Online publication date: 1-Jul-2021. Xiang P, Jing W, Lin Y, Liu Q, Shen J, Hu X, Chen J, Cai R, Hare J, Zhu W, Schally A and Yu H (2021) Improvement of cardiac and systemic function in old mice by agonist of growth hormone‐releasing hormone, Journal of Cellular Physiology, 10.1002/jcp.30490, 236:12, (8197-8207), Online publication date: 1-Dec-2021. Katsanos S, Saranteas T and Mavrogenis A (2021) Orthopaedic cardiac considerations in emergency, SICOT-J, 10.1051/sicotj/2021051, 7, (E2), . Grivas P, Plimack E, Balar A, Castellano D, O'Donnell P, Bellmunt J, Powles T, Hahn N, de Wit R, Bajorin D, Ellison M, Frenkl T, Godwin J and Vuky J (2020) Pembrolizumab as First-line Therapy in Cisplatin-ineligible Advanced Urothelial Cancer (KEYNOTE-052): Outcomes in Older Patients by Age and Performance Status, European Urology Oncology, 10.1016/j.euo.2020.02.009, 3:3, (351-359), Online publication date: 1-Jun-2020. Tassell M, Keaveney A, Kingston R, Gilroy D, Lehane M, Lucey B and Furey A (2020) Synergy in Whole Plant Medicine: Crataegus spp .: An Example Herbs, Spices and Medicinal Plants, 10.1002/9781119036685.ch9, (251-281), Online publication date: 12-Oct-2020. Lee M, Hsu P, Tsai W, Chen Y, Lee H, Lee W, Chu C, Lee C, Yen H, Lin T, Voon W, Lai W, Sheu S and Su H (2020) Gender differences in major adverse cardiovascular outcomes among aged over 60 year-old patients with atherosclerotic cardiovascular disease, Medicine, 10.1097/MD.0000000000019912, 99:19, (e19912), Online publication date: 1-May-2020. Calderón-Larrañaga A, Saadeh M, Hooshmand B, Refsum H, Smith A, Marengoni A and Vetrano D (2020) Association of Homocysteine, Methionine, and MTHFR 677C>T Polymorphism With Rate of Cardiovascular Multimorbidity Development in Older Adults in Sweden , JAMA Network Open, 10.1001/jamanetworkopen.2020.5316, 3:5, (e205316) Mottet N, Ribal M, Boyle H, De Santis M, Caillet P, Choudhury A, Garg T, Nielsen M, Wüthrich P, Gust K, Shariat S and Gakis G (2020) Management of bladder cancer in older patients: Position paper of a SIOG Task Force, Journal of Geriatric Oncology, 10.1016/j.jgo.2020.02.001, 11:7, (1043-1053), Online publication date: 1-Sep-2020. Testai L, Citi V, Martelli A, Brogi S and Calderone V (2020) Role of hydrogen sulfide in cardiovascular ageing, Pharmacological Research, 10.1016/j.phrs.2020.105125, 160, (105125), Online publication date: 1-Oct-2020. Chan E, Seto S, Au Yeung T and Chan G (2019) Chinese Herbal Medicine in the Management of Atherosclerosis-Related Chronic Conditions in an Aging Population Complementary and Alternative Medicine, 10.4018/978-1-5225-7039-4.ch028, (593-615) Chan E, Seto S, Au Yeung T and Chan G (2019) Chinese Herbal Medicine in the Management of Atherosclerosis-Related Chronic Conditions in an Aging Population Chronic Illness and Long-Term Care, 10.4018/978-1-5225-7122-3.ch012, (218-240) Saranteas T, Spiliotaki H, Koliantzaki I, Koutsomanolis D, Kopanaki E, Papadimos T and Kostopanagiotou G (2019) The Utility of Echocardiography for the Prediction of Spinal-Induced Hypotension in Elderly Patients: Inferior Vena Cava Assessment Is a Key Player, Journal of Cardiothoracic and Vascular Anesthesia, 10.1053/j.jvca.2019.02.032, 33:9, (2421-2427), Online publication date: 1-Sep-2019. Sarvepalli J, Santhakumar R and Verma R (2019) Evolving Concepts for Use of Stem Cells and Tissue Engineering for Cardiac Regeneration Coronary and Cardiothoracic Critical Care, 10.4018/978-1-5225-8185-7.ch024, (509-543) Gallart-Palau X, Tan L, Serra A, Gao Y, Ho H, Richards A, Kandiah N, Chen C, Kalaria R and Sze S (2019) Degenerative protein modifications in the aging vasculature and central nervous system: A problem shared is not always halved, Ageing Research Reviews, 10.1016/j.arr.2019.100909, 53, (100909), Online publication date: 1-Aug-2019. Myakotnykh V, Ostapchuk E and Postovalova V (2019) The Main Diseases and Syndromes Identified in Elderly and Senile Patients Hospitalized at Inpatient Clinics of Different Specialties, Advances in Gerontology, 10.1134/S2079057019010107, 9:1, (101-108), Online publication date: 1-Jan-2019. Zhang W, Song M, Qu J and Liu G (2018) Epigenetic Modifications in Cardiovascular Aging and Diseases, Circulation Research, 123:7, (773-786), Online publication date: 14-Sep-2018. Chen Y, Yang X, Nguyen Pham V, Huang S, Fu G, Chen X, Quang Truong B, Yang Y, Liu S, Chen X, Ma T, Kim D and Kim T (2017) Heart rate control is associated with reduced cardiovascular events in Asian patients with coronary artery disease treated with bisoprolol (BISO-CAD): results from a multi-national, real-world experience, Current Medical Research and Opinion, 10.1080/03007995.2017.1363729, 34:2, (217-225), Online publication date: 1-Feb-2018. Harada D, Aasanoi H, Ushijima R, Noto T, Takagawa J, Ishise H and Inoue H (2017) Impact of right ventricular distensibility on congestive heart failure with preserved left ventricular ejection fraction in the elderly, Heart and Vessels, 10.1007/s00380-017-1092-2, 33:6, (605-614), Online publication date: 1-Jun-2018. Liu G, Zhu H, Cai W, Wang X, Jiang M, Essandoh K, Vafiadaki E, Haghighi K, Lam C, Gardner G, Adly G, Nicolaou P, Sanoudou D, Liang Q, Rubinstein J, Fan G and Kranias E (2018) Regulation of BECN1-mediated autophagy by HSPB6: Insights from a human HSPB6 S10F mutant , Autophagy, 10.1080/15548627.2017.1392420, 14:1, (80-97), Online publication date: 2-Jan-2018. Chan E, Seto S, Au Yeung T and Chan G (2018) Chinese Herbal Medicine in the Management of Atherosclerosis-Related Chronic Conditions in an Aging Population Sustainable Health and Long-Term Care Solutions for an Aging Population, 10.4018/978-1-5225-2633-9.ch017, (320-342) Rai R, Ghosh A, Eren M, Mackie A, Levine D, Kim S, Cedernaes J, Ramirez V, Procissi D, Smith L, Woodruff T, Bass J and Vaughan D (2017) Downregulation of the Apelinergic Axis Accelerates Aging, whereas Its Systemic Restoration Improves the Mammalian Healthspan, Cell Reports, 10.1016/j.celrep.2017.10.057, 21:6, (1471-1480), Online publication date: 1-Nov-2017. Sayar F, Akhondi N, Fallah S, Moalemnia A and Cheraghi A (2017) Association of Serum Triglyceride Level and Gemfibrozil Consumption With Periodontal Status, Journal of Periodontology, 10.1902/jop.2016.160366, 88:5, (457-463), Online publication date: 1-May-2017. Saranteas T, Manikis D, Papadimos T, Mavrogenis A, Kostopanagiotou G and Panou F (2016) Intraoperative TTE inferior vena cava monitoring in elderly orthopaedic patients with cardiac disease and spinal-induced hypotension, Journal of Clinical Monitoring and Computing, 10.1007/s10877-016-9922-9, 31:5, (919-926), Online publication date: 1-Oct-2017. Favero G, Franceschetti L, Buffoli B, Moghadasian M, Reiter R, Rodella L and Rezzani R (2017) Melatonin: Protection against age-related cardiac pathology, Ageing Research Reviews, 10.1016/j.arr.2016.11.007, 35, (336-349), Online publication date: 1-May-2017. Williams J, Smith F, Kumar S, Vijayan M and Reddy P (2017) Are microRNAs true sensors of ageing and cellular senescence?, Ageing Research Reviews, 10.1016/j.arr.2016.11.008, 35, (350-363), Online publication date: 1-May-2017. Jeddi S, Zaman J and Ghasemi A (2016) Effect of fetal hypothyroidism on tolerance to ischemia–reperfusion injury in aged male rats: Role of nitric oxide, Nitric Oxide, 10.1016/j.niox.2016.04.001, 55-56, (82-90), Online publication date: 1-May-2016. Zhang Z, Hong Z, Wang Y, He L, Wang N, Zhao Z, Zhao G, Shang L, Weisskopf M, Callegari F and Strohmaier C (2016) Rivastigmine Patch in Chinese Patients with Probable Alzheimer's disease: A 24-week, Randomized, Double-Blind Parallel-Group Study Comparing Rivastigmine Patch (9.5 mg/24 h) with Capsule (6 mg Twice Daily), CNS Neuroscience & Therapeutics, 10.1111/cns.12521, 22:6, (488-496), Online publication date: 1-Jun-2016. Valiathan R, Ashman M and Asthana D (2016) Effects of Ageing on the Immune System: Infants to Elderly, Scandinavian Journal of Immunology, 10.1111/sji.12413, 83:4, (255-266), Online publication date: 1-Apr-2016. Bellmunt J, Mottet N and De Santis M (2016) Urothelial carcinoma management in elderly or unfit patients, European Journal of Cancer Supplements, 10.1016/j.ejcsup.2016.01.001, 14:1, (1-20), Online publication date: 1-Mar-2016. Sarvepalli J, Santhakumar R and Verma R (2016) Evolving Concepts for Use of Stem Cells and Tissue Engineering for Cardiac Regeneration Optimizing Assistive Technologies for Aging Populations, 10.4018/978-1-4666-9530-6.ch011, (279-313) Costantino S, Paneni F and Cosentino F (2015) Ageing, metabolism and cardiovascular disease, The Journal of Physiology, 10.1113/JP270538, 594:8, (2061-2073), Online publication date: 15-Apr-2016. Park H, Kang H, Lee J, Baek S and Seo J (2015) Comparison of hemodynamic changes between old and very old patients undergoing cemented bipolar hemiarthroplasty under spinal anesthesia, Korean Journal of Anesthesiology, 10.4097/kjae.2015.68.1.37, 68:1, (37), . Ghimire S and Kim M (2015) Enhanced Locomotor Activity Is Required to Exert Dietary Restriction-Dependent Increase of Stress Resistance in Drosophila , Oxidative Medicine and Cellular Longevity, 10.1155/2015/813801, 2015, (1-8), . Chung W, Chu Y, Lin C and Kao C (2015) Increased risk of acute coronary syndrome among leptospirosis patients: A nationwide cohort analysis, International Journal of Cardiology, 10.1016/j.ijcard.2015.03.021, 184, (576-580), Online publication date: 1-Apr-2015. Ghimire S and Kim M (2015) Defensive Behavior against Noxious Heat Stimuli Is Declined with Aging Due to Decreased Pain-Associated Gene Expression in Drosophila, Biomolecules & Therapeutics, 10.4062/biomolther.2014.147, 23:3, (290-295), Online publication date: 31-May-2015. Corella D and Ordovás J (2014) Aging and cardiovascular diseases: The role of gene–diet interactions, Ageing Research Reviews, 10.1016/j.arr.2014.08.002, 18, (53-73), Online publication date: 1-Nov-2014. Agaku I, Ayo-Yusuf O and Vardavas C (2014) A Comparison of Cessation Counseling Received by Current Smokers at US Dentist and Physician Offices During 2010–2011, American Journal of Public Health, 10.2105/AJPH.2014.302049, 104:8, (e67-e75), Online publication date: 1-Aug-2014. Chung W, Lin C, Hsu W and Kao C (2014) Scrub typhus increases the risk of developing acute coronary syndrome: a nationwide cohort study, Heart, 10.1136/heartjnl-2014-306181, 100:23, (1844-1850), Online publication date: 1-Dec-2014. Medeiros L, Ramiro F, Lima C, Souza L, Fortes T and Groppo F (2013) Avaliação do grau de ansiedade dos pacientes antes de cirurgias orais menores, Revista de Odontologia da UNESP, 10.1590/S1807-25772013000500007, 42:5, (357-363), Online publication date: 1-Oct-2013. Hung C, Wu Y, Liu C, Chi B, Chang S, Wang L, Yeh H and Wei Y (2012) Rationale and Design of MAGNET (Mitochondria-AGing in NorthErn Taiwan) Study: A Community-based Cohort Investigating Mitochondria-related Aging and Cardiovascular Diseases in Suburban Areas of Northern Taiwan, International Journal of Gerontology, 10.1016/j.ijge.2012.05.014, 6:2, (122-126), Online publication date: 1-Jun-2012. Giamberardino M, Affaitati G and Costantini R (2010) Visceral Referred Pain, Journal of Musculoskeletal Pain, 10.3109/10582452.2010.502624, 18:4, (403-410), Online publication date: 1-Oct-2010. Yan J, Greer J, Hull R, O'Sullivan J, Henderson R, Read S and McCombe P (2010) The effect of ageing on human lymphocyte subsets: comparison of males and females, Immunity & Ageing, 10.1186/1742-4933-7-4, 7:1, Online publication date: 1-Dec-2010. Verny C (2007) Congestive heart failure in the elderly diabetic, Diabetes & Metabolism, 10.1016/S1262-3636(07)80055-3, 33, (S32-S39), Online publication date: 1-Apr-2007. Pi-Sunyer F (2006) The Metabolic Syndrome: How to Approach Differing Definitions, Obesity Management, 10.1089/obe.2006.2.58, 2:2, (58-62), Online publication date: 1-Apr-2006. Giamberardino M, Affaitati G and Costantini R (2006) Chapter 24 Referred pain from internal organs PAIN, 10.1016/S0072-9752(06)80028-X, (343-361), . Rodriguez-Ziccardi M, Rubio M, Lu M and Greenspan A (2018) Ventricular tachyarrhythmia in a 78-year-old woman with essential thrombocythaemia, BMJ Case Reports, 10.1136/bcr-2017-220723, (bcr-2017-220723) Sun J, Tai S, Tang L, Yang H, Chen M, Xiao Y, Li X, Zhu Z and Zhou S (2021) Acetylation Modification During Autophagy and Vascular Aging, Frontiers in Physiology, 10.3389/fphys.2021.598267, 12 Hu Z, Zheng B, Kaminga A, Zhou F and Xu H (2022) Association Between Functional Limitations and Incident Cardiovascular Diseases and All-Cause Mortality Among the Middle-Aged and Older Adults in China: A Population-Based Prospective Cohort Study, Frontiers in Public Health, 10.3389/fpubh.2022.751985, 10 Testai L, Brancaleone V, Flori L, Montanaro R and Calderone V (2021) Modulation of EndMT by Hydrogen Sulfide in the Prevention of Cardiovascular Fibrosis, Antioxidants, 10.3390/antiox10060910, 10:6, (910) Zhou Y, Huo Q, Du S, Shi X, Shi Q, Cui S, Feng C, Du X and Wang Y (2022) Social Support and Self-Efficacy as Mediating Factors Affecting the Association Between Depression and Medication Adherence in Older Patients with Coronary Heart Disease: A Multiple Mediator Model with a Cross-Sectional Study, Patient Preference and Adherence, 10.2147/PPA.S337634, Volume 16, (285-295) Dela Justina V, Miguez J, Priviero F, Sullivan J, Giachini F and Webb R (2021) Sex Differences in Molecular Mechanisms of Cardiovascular Aging, Frontiers in Aging, 10.3389/fragi.2021.725884, 2 Horn M (2015) Cardiac Physiology of Aging: Extracellular Considerations Comprehensive Physiology, 10.1002/cphy.c140063, (1069-1121) Aberdeen H, Battles K, Taylor A, Garner-Donald J, Davis-Wilson A, Rogers B, Cavalier C and Williams E (2021) The Aging Vasculature: Glucose Tolerance, Hypoglycemia and the Role of the Serum Response Factor, Journal of Cardiovascular Development and Disease, 10.3390/jcdd8050058, 8:5, (58) October 7, 2003Vol 108, Issue 14 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000086898.96021.B9PMID: 14530186 Originally publishedOctober 7, 2003 PDF download Advertisement
Referência(s)