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Journal of Applied Physiology publishes original papers that deal with diverse area of research in applied
physiology, especially those papers emphasizing adaptive and integrative mechanisms. It is published 12 times a
year (monthly) by the American Physiological Society, 9650 Rockville Pike, Bethesda MD 20814-3991. Copyright
2003 the American Physiological Society. ISSN: 8750-7587, ESSN: 1522-1601. Visit our website at
http://www.the-aps.org/.
highlighted topics
Physiology of Aging
Invited Review: Aging and the cardiovascular system
Alberto U. Ferrari, Alberto Radaelli, and Marco Centola
Dipartimento di Medicina, Prevenzione e Biotecnologie Sanitarie, Centro di Fisiologia
Clinica e Ipertensione, Universita` di Milano-Bicocca, 20122 Milano; Divisione di
Cardioriabilitazione, Ospedale di Seregno, Azienda Ospedaliera Vimercate (MI), 20059 Vimercate, Italy
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Ferrari, Alberto U., Alberto Radaelli, and Marco Centola. Invited Review: Aging and the cardiovascular system. J Appl Physiol 95:
25912597, 2003; 10.1152/japplphysiol.00601.2003.Aging is associated with complex and diversified changes of cardiovascular structure
and function. The heart becomes slightly hypertrophic and hyporesponsive to sympathetic (but not parasympathetic) stimuli, so that the exercise-induced increases in heart rate and myocardial contractility are
blunted in older hearts. The aorta and major elastic arteries become
elongated and stiffer, with increased pulse wave velocity, evidence of
endothelial dysfunction, and biochemical patterns resembling early atherosclerosis. The arterial baroreflex is sizably altered in aging, but
different components are differentially affected: there is a definite impairment of arterial baroreceptor control of the heart but much better
preserved baroreceptor control of peripheral vascular resistance. Alterations at the afferent, central neural, efferent, and effector organ portions of the reflex arch have been claimed to account for age-related
baroreflex changes, but no conclusive evidence is available on this mechanistic aspect. Reflexes arising from cardiopulmonary vagal afferents are
also blunted in aged individuals. The cardiovascular and reflex changes
brought about by aging may have significant implications for circulatory
homeostasis in health and disease.
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INVITED REVIEW
Table 1. Effects of aging on major structural and functional characteristics of the cardiovascular system
Cardiac Changes
Vascular Changes
Heart weight
Cardiomyocyte dimensions
Cardiomyocyte number
Collagen in cross-linking
Ejection fraction
Stroke volume
Cardiac output
Early diastolic filling
End-diastolic filling
Chronotropic responsiveness to -adrenergic stimuli/catecholamines
Inotropic responsiveness to -adrenergic stimuli/catecholamines
Inotropic response to digitalis glycosides
Peak cardiac output to maximal effort
Lusitropic function
Release of natriuretic peptides
1
1
2
1
2
1
2
2
2
2
2
1
1
1
2
1
1
1
1
2
1
1
1
2
1
2
2
2, diminished; 1, augmented; , unchanged; VSMC, vascular smooth muscle cells; SOD, superoxide dismutase; MMP, matrix metalloproteinases.
Structural changes. Aging large arteries are elongated and tortuous and have an enlarged lumen and a
thickened wall, the thickening mainly affecting the
intima and the media (44). In the former, arteries from
healthy elderly subjects show no endothelial lesions or
discontinuities; endothelial cells may, however, be irregular in shape and have increased height; there may
be migration and/or proliferation of vascular smooth
muscle cells, with infiltration in the subendothelial
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pressure was examined by the neck chamber technique: when carotid baroreceptor deactivation was produced by applying positive neck pressure for 2-min
periods, the late, steady-state reflex blood pressure rise
was largely similar in the different age groups,
whereas the early response was significantly attenuated in the older compared with the younger subjects
(14). Although based on different techniques, the parallel findings on age-related effects obtained in humans
and rats do support the notion that, with aging, baroreceptor control of blood pressure is quantitatively preserved but has a significantly slowed time course.
More recently, a novel approach to quantitate the
blood pressure-buffering ability of arterial baroreflexes
was used to compare this function in older vs. younger
humans (22): transient blood pressure elevations were
produced by intravenous administration of phenylephrine in the control condition and during ganglionic
blockade by trimetaphan, the potentiation of the response under the latter condition being taken as a
measure of the reflex blood pressure buffering capability. Older subjects clearly showed attenuated potentiation of the pressor responses during trimetaphan
blockade, and the authors concluded that aging is associated with impaired baroreflex buffering; this conclusion may not be definitive, however, because this
albeit ingenious approach is not devoid of limitations,
as discussed by the authors themselves, insofar as
phenylephrine is not selectively acting on resistance
arterioles. Even more importantly, trimetaphan drastically lowered systemic blood pressure and did so to a
quite different extent in the two age groups (much
more markedly and indeed almost to shock-like levels
in aged subjects), which may complicate the interpretation of the results. Thus the issue of the age-related
J Appl Physiol VOL
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34.
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