. Author manuscript; available in PMC: 2023 Jun 30.

Published in final edited form as: Circulation. 2022 Dec 12;147(3):e32–e62. doi: 10.1161/CIR.0000000000001112

Table 1.

Normal cardiovascular aging and risk for acute coronary syndromes.

Age-related Change	Implications for ACS
Increased central aortic stiffness due to increased collagen crosslinking and elastin fiber degeneration	Increased impedance to LV ejection, increased SBP and pulse pressure, increased myocardial work and O₂ demand, decreased coronary perfusion pressure
Altered LV diastolic relaxation and increased myocardial stiffness	Increased resistance to coronary perfusion; predisposition to atrial fibrillation and HFpEF
Decreased responsiveness to β-adrenergic stimulation	Decreased maximum HR and contractility, decreased peak cardiac output, decreased peripheral vasodilation
Impaired endothelium-mediated vasodilation	Decreased peak coronary blood flow and coronary flow reserve; increased atherogenesis; increase in vascular impedance as a result of impaired endothelium mediated vasodilatation.
Altered balance between intrinsic thrombosis and fibrinolysis	Increased risk for venous and arterial thromboembolism
Chronic low-grade inflammation (inflammaging^†)	Increased atherogenesis and geriatric syndromes, including frailty

^†

Not a normal age-related change but prevalent at advanced age.

Abbreviations: ACS: acute coronary syndrome; HFpEF: heart failure with preserved ejection fraction; HR: heart rate; LV: left ventricular; SBP: systolic blood pressure.