Cellular Senescence, Vascular Disease, and Aging Part 1 of a 2-Part Review

> Longevity is a vascular question, which has been well expressed in the axiom that man is only as old as his arteries. To a majority of men death comes primarily or secondarily through this portal. The onset of what may be called physiological arterio-sclerosis depends, in the first place, on the quality of arterial tissue which the individual has inherited, and secondarily on the amount of wear and tear to which he has subjected it. > > —Sir William Osler, 18911 In 2030, when all of the baby boomer generation will be ≥65 years of age, nearly 1 in 5 US residents is expected to be >65 years of age. By 2050, this age group is projected to more than double in number, from 38.7 million in 2008 to an estimated 88.5 million (Figure 1).2 Similarly, the population ≥85 years of age is expected to more than triple, from 5.4 million in 2008 to 19 million by 2050.2 With this aging of the population, the number of people at risk for adverse cardiovascular events, in particular atherothrombosis, stroke, myocardial infarction, and heart failure, will increase dramatically. The importance of these projections is underscored by the fact that currently, although octogenarians represent only 5% of the US population, they account for 20% of all hospitalizations for myocardial infarction and 30% of all myocardial infarction–related deaths.3 Figure 1. Projected US population demographics by age and sex in 2010 (top), 2030 (middle), and 2050 (bottom). The baby boomer cohort (Baby Boom) is also highlighted. Source: Population Division, US Census Bureau.2 Despite their increased risk of adverse cardiac events, elderly patients are less likely to receive appropriate therapy. This paradox is perhaps related to the fact that elderly patients with cardiovascular disease are more likely to be frail.4 Heightened concerns that frail older patients may be …