Keynote lecture: strategies for optimal cardiovascular aging

Abstract

This review summarizes the opening keynote presentation overview of the American Physiological Society Conference on Cardiovascular Aging: New Frontiers and Old Friends held in Westminster, CO, in August 2017. Age is the primary risk factor for cardiovascular diseases (CVDs). Without effective intervention, future increases in the number of older adults will translate to a greater prevalence of CVDs and related disorders. Advancing age increases the risk of CVDs partly via direct effects on the heart and through increases in blood pressure; however, much of the risk is mediated by vascular dysfunction, including large elastic artery stiffening and both macro- and microvascular endothelial dysfunction. Although excessive superoxide-related oxidative stress and chronic low-grade inflammation are the major processes driving cardiovascular aging, the upstream mechanisms involved represent new frontiers of investigation and potential therapeutic targets. Lifestyle practices, including aerobic exercise, energy intake (caloric) restriction, and healthy diet composition, are the most evidence-based strategies (old friends) for optimal cardiovascular aging, but adherence is poor in some groups. Healthy lifestyle "mimicking" approaches, including novel forms of physical training, intermittent fasting paradigms, exercise/healthy diet-inspired nutraceuticals (functional foods and natural supplements), as well as controlled environmental stress exposure (e.g., heat therapy), may hold promise but are unproven. Mitigating the adverse effects of aging on cardiovascular function and health is a high biomedical priority.

Keywords: caloric restriction; energy sensing; mitochondrial dysfunction; nitric oxide.

Fig. 1.

Top: established and putative cellular and molecular mechanisms driving cardiovascular dysfunction and common clinical disorders of aging. Bottom: lifestyle and pharmacological strategies may protect against the development of cardiovascular dysfunction with aging (primary prevention) and/or improve existing dysfunction to slow progression to clinical disorders (secondary prevention).

Fig. 2.

Healthy lifestyle- and pharmacological-based approaches for achieving healthy cardiovascular aging, from old friends (the most evidence-based strategies) to new frontiers (promising interventions that remain unproven).