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Review
. 2024 May;12(5):795-809.
doi: 10.1016/j.jchf.2024.02.021. Epub 2024 Apr 8.

Aging in Heart Failure: Embracing Biology Over Chronology: JACC Family Series

Parag Goyal  1 , Mathew S Maurer  2 , Jason Roh  3
Affiliations
Review

Aging in Heart Failure: Embracing Biology Over Chronology: JACC Family Series

Parag Goyal et al. JACC Heart Fail. 2024 May.

Abstract

Age is among the most potent risk factors for developing heart failure and is strongly associated with adverse outcomes. As the global population continues to age and the prevalence of heart failure rises, understanding the role of aging in the development and progression of this chronic disease is essential. Although chronologic age is on a fixed course, biological aging is more variable and potentially modifiable in patients with heart failure. This review describes the current knowledge on mechanisms of biological aging that contribute to the pathogenesis of heart failure. The discussion focuses on 3 hallmarks of aging-impaired proteostasis, mitochondrial dysfunction, and deregulated nutrient sensing-that are currently being targeted in therapeutic development for older adults with heart failure. In assessing existing and emerging therapeutic strategies, the review also enumerates the importance of incorporating geriatric conditions into the management of older adults with heart failure and in ongoing clinical trials.

Keywords: aging biology; geriatrics; heart failure.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Goyal has received grant support from National Institutes of Health (NIH) grants K76AG064428 and R21AG077092; and has received personal fees from Sensorum Health, Agepha Pharma, and Axon Therapies. Dr Maurer has received grant support from NIH grants R01HL139671 and R01AG081582-01; has received grants and personal fees from Alnylam, Pfizer, Eidos, Prothena, and Ionis; and has received personal fees from AstraZeneca, Akcea, Intellia, and Novo Nordisk. Dr Roh has received grant support from NIH grants K76AG064328 and R01HL170058, Hassenfeld Scholars Award, MGH Transformative Scholars Award, and the Fred and Ines Yeatts Fund for Innovative Research; and has received research support from Genentech, Amgen, and Keros Therapeutics.

Figures

FIGURE 1
FIGURE 1. Interaction of Biological Aging With Environment and Lifestyle to Generate Heart Failure Phenotype
Interactive concentric model (adapted from Inouye et al) displaying how biological aging interacts with environment and lifestyle to cause geriatric conditions and heart failure (HF) in older adults. Identifying synergistic pathways offers a locus for the rational design and development of targeted interventions and gerotherapeutics
CENTRAL ILLUSTRATION
CENTRAL ILLUSTRATION. Aging Processes in Heart Failure
Physiological and biological aging of the cardiovascular system underlie the strong association between chronologic age and heart failure. This figure depicts the evolution of how “age” is being studied in heart failure and the shifting importance from chronologic to biological age in management of older adults with heart failure. The figure incorporates the updated hallmarks of aging outlined by Lopez-Otin et al and was partly generated using Servier Medical Art, provided by Servier, licensed under a Creative Commons Attribution 3.0 unported license.
See this image and copyright information in PMC

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