THE ART OF THE HEART

The aging of our population has dramatically changed the nature of medical practice in the United States in the last 50 years. A scientific understanding of how the body, in particular the heart, aged once someone passed their 65th birthday wasn't a major medical issue prior to World War II; average life expectancy simply wasn't such that a significant portion of the population through the first half of the 20th Century would live beyond 70 anyway. But now, according to the Society of Geriatric Cardiology (SGC), it is anticipated that, by the year 2030, there will be 51.4 million people in the United States over 65, including 7.1 million over age 85. Currently, in the greater Sacramento area the number of adults 50+ years of age is more than 1 million (source: Fall 2000 Arbitron).

The SGC attributes the increase in the aging population in part to "the large number of individuals of all ages who are actively modifying adverse lifestyles and thereby postponing premature death from degenerative diseases." The sheer numbers of Baby Boomers entering the "senior" phase of life also has something to do with the expected significant increase of people in the over 65 category in the coming decades.

But while people are living longer, we're finding that those added years of life are, in many instances, limited by cardiovascular disease and changes that occur to the heart as we age.

Cardiovascular disease (heart attack, angina, congestive heart failure, arrhythmia) is a leading cause of death and disability in persons over the age of 65. Age-related changes in cardiovascular function and structure may worsen cardiovascular disease. A thorough understanding of aging is important when treating older adults, and the more we study this population the more we learn about the nuances of treating a population with greater longevity than ever.

Geriatric cardiology is a new subspecialty of cardiology dedicated to reducing the burden of cardiovascular disease in older people and improving the care of older adults with cardiovascular disorders. Geriatric cardiologists have special training in the effect of aging on cardiovascular disease and place emphasis on improving quality of life and longevity in older adults. Geriatric cardiologists focus on diagnosis, treatment and prevention of cardiovascular disease in older adults who often have numerous other medical problems. Like so many other areas of medicine we're finding it's to the benefit of both patient and physician to treat the whole person in other words take into account changes in lifestyle, the patient's emotional well-being, how conditions like Alzheimer's or increased frailty might be impacting the patient, and other areas that haven't in the past been traditionally considered when dealing with cardiovascular disease.

On the other side of the coin we are also developing a deeper understanding of the increasing percentage of our aging population who have been very physically active throughout their adult life and are maintaining superb physical conditioning well into their 70's and 80's. Much is being learned from these patients about the aging heart in a healthy body.

The National Institute on Aging's (NIA) studies of normal aging have revealed that the heart does indeed change with age, but now we're learning that change doesn't necessarily mean deterioration. Where doctors once thought marked declines in overall heart function were the norm, we are now seeing that the heart can adapt to a healthy, active lifestyle and be conditioned. Since the 1970's we've learned that the walls of the heart thicken with age; the theory now is that the increased thickness allows the walls of the heart to compensate for extra stresses they bear with age (such as stress caused by pumping blood into stiffer blood vessels). When walls thicken, stress is spread out over a larger area. (Source: National Institute on Aging)

That brings us back to the SGI statement that individuals actively modifying adverse lifestyles are postponing premature death from degenerative diseases. The NIA reports that there is now evidence that the healthy changes that occur in young people who exercise regularly (lower resting heart rate, higher heart mass, greater amount of blood pumped with each heart beat) will also occur even when exercise training begins later in life, at age 60 or 70 for instance.

With the inauguration of our own geriatric cardiology program at the Sacramento Heart Center, 500 University Avenue, we will be focusing not only on cardiac care in concert with other medical concerns of our aging patients, but on the continued healthy functioning of the heart in our active, physically fit patients who fall into that over 65 category. To find out if you should consider adding a geriatric cardiology specialist to your personal team of physicians, simply call (916) 830-2080 to schedule a consultation with our geriatric cardiology department. For more information about the Sacramento Heart Center, call 830-2080 and request information be mailed to you. Please address your Cardiology related questions to "Ask the Cardiologist", 500 University Avenue, Sacramento, CA 95825. Selected questions will be answered in future articles.