[Ageing of the arterial wall]

Abstract

Several mechanisms are implicated in the arterial wall changes due to ageing: ageing, hypertension and atherosclerosis. Although the changes related to ageing (arteriosclerosis) have many factors in common with those induced by hypertension, they differ from those caused by atherosclerosis although commonly associated. Arteriosclerosis causes a diffuse increase of the rigidity of the large arteries by disease of the media, the main clinical manifestation of which is the increase in pulsed pressure. This arterial "hyperpulsability" contributes to a defect in coupling between the heart and the blood vessels which results in an increase in the pulsatile load of the left ventricle and to left ventricular hypertrophy and decreased coronary perfusion. Atherosclerosis seems more of a localised scarring phenomenon of the arterial wall which is exposed to a series of chronic aggressions characterised by deposits of lipids in the intima and whose main complication is thrombosis. Although these two processes may be associated, or interact one with the other, they are clearly different in nature. Therefore, atherosclerosis is a localised disease resulting in a decrease in arterial lumen, quite different from arteriosclerosis which is a diffuse, physiological condition which leads to an increase in the arterial lumen.