ACCEL | What is normal aging and what is disease? There is vascular aging and extreme vascular aging. Take a look at a healthy eight-year-old’s carotids and you see normal layers of artery that look like a smooth roadway, with the intima and adventitia setting the boundaries of the road and the media itself defining the “open road.” By age 52, aging has caused changes to the intima media thickness leaving less of a roadway and the look of more of a gently rolling hills; by 85, that once-narrow open road now looks like a graphic relief map of the Rocky Mountains. Show
Due to advancing age in general, and the rate of calcification in particular, there are changes in arteries over time. The question is: What is normal aging and what is disease? Take-aways
In the past, vascular stiffening and an increase in systolic and pulse pressure have been considered part of normal aging. However, increasing evidence points to arterial stiffness as a critical precursor of disease. Of course, arterial stiffness increases with age independently of the presence of cardiovascular risk factors or other associated conditions, but the extent of this increase may depend on several environmental or genetic factors, as demonstrated in a large body of work by Francesco Mattace-Raso, MD, PhD, head of geriatric medicine at Erasmus University Medical Center, Rotterdam, Netherlands. Vascular stiffening and the subsequent increase in systolic and pulse pressure have, in the past, been considered a part of normal aging. Aside from aging, however, high arterial stiffness has also been associated with hypertension, diabetes mellitus, end-stage renal disease, and atherosclerosis. Emerging evidence has also shown an association between increased arterial stiffness and incident CVD in patients with hypertension and end-stage renal disease. Growing insights into the mechanisms underlying stiffness make it a potential target for intervention and prevention of cardiovascular disease. Study UpdatesMattace-Raso and colleagues have contributed much to our current understanding of arterial (especially aortic) stiffness and associated risk factors:
Extreme Vascular AgingIn brief, vascular aging is a normal process that influences long- and short-term risk, but in the presence of specific factors, the result is extreme vascular aging that increases morbidity and mortality. Dr. Mattace-Raso and his team have studied elastin, the connective tissue that allows many tissues in the body to resume their shape after stretching or contracting. With age, there is a thinning and fracturing of elastin and increased collagen deposition, resulting in an increased stiffening of the vessel walls that is more pronounced in the central, predominantly elastic arteries, compared to the distal, predominantly muscular arteries. With age alone, elastin maintains most of its integrity for 50 years. It essentially has a half-life of 50 years; that means by 80 years of age elastin has lost a substantial amount of its natural integrity. Looking at it another way, beyond 50 years, age alone greatly impacts the integrity of elastin. Other variables will impact elastin, too: a higher mean arterial pressure, for example, stretches elastin and collagen fibers in the arterial wall, making the arteries less distensible. Overall, the specifics of what causes these “aging effects” remain largely unclear. Dr. Mattace-Raso suggests large population-based studies to determine whether age-related hormonal changes, nutritional patterns, physical activity, and possible interactions of genetic and environmental factors can influence functional vascular properties. One step in that direction: Mattace-Raso et al. were the first to establish reference and normal values for carotid–femoral PWV, using almost 17,000 European subjects and patients and standardizing results for different methods of PWV measurement.6 On the basis of the distribution of PWV within each age and BP category, it is now possible to identify those people at higher risk than others in a certain age group and in which percentile of reference (or normal) population an individual subject stands. Overall, Dr. Mattace-Raso said generalized arterial stiffness should no longer be considered an innocent expression of vascular aging, but rather a sign of increased cardiovascular risk. Measurement of PWV is noninvasive, easy to apply, allows a functional assessment of the arterial tree, and should be considered as an additional tool to identify subjects at high risk of cardiovascular disease. References
Keywords: CardioSource WorldNews, ACC Publications < Back to Listings Which clinical condition will result in changes in the integrity of the arterial walls and small blood vessels?Atherosclerosis is a narrowing of the arteries caused by a buildup of plaque. Arteries are the blood vessels that carry oxygen and nutrients from your heart to the rest of your body.
Which site would the nurse assess to confirm cyanosis?Cheeks, nose, ears, and oral mucosa are the best areas to assess cyanosis as the skin in these areas is thin, and blood supply is good. This can help determine if the cyanosis is generalized, limited to extremities, or if there is a difference in the bluish discoloration in different extremities.
Which term refers to a blowing sound created by turbulence caused by narrowing of arteries while assessing the carotid pulse?A heart murmur is a blowing, whooshing, or rasping sound heard during a heartbeat. The sound is caused by turbulent (rough) blood flow through the heart valves or near the heart.
Which degree of edema will result in 6 mm deep indentation on pressure application?Grade 3: Noticeably deep pit (6 mm) with the dependent extremity full and swollen that takes up to 30 seconds to rebound.
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