ORIGINAL RESEARCHREVIEW TheCoronary aging process artery diseaseand potential in women: interventions a review toon extendprevention, life expectancy pathophysiology, diagnosis, and treatment Author copy only Matteo Tosato1 Abstract: Aging is commonly defi ned as the accumulation of diverse deleterious changes Valentina Zamboni1 occurring in cells and tissues with advancing age that are responsible for the increased risk of Leila Fernandes Araujo Abstract: Despite numerous studies on women’s cardiac health throughout the past decade, the 1 disease and death. The major theories of aging are all specifi c of a particular cause of aging, pro- AlessandroAlexandre deFerrini Matos Soeiro number of female deaths caused by cardiovascular disease still rises and remains the leading cause 1,2 viding useful and important insights for the understanding of age-related physiological changes. Matteo Cesari of death in women in most areas of the world. Novel studies have demonstrated that cardiovascular Juliano Lara Fernandes However, a global view of them is needed when debating of a process which is still obscure 1Department of Gerontology, disease, and more specifically coronary artery disease presentations in women, are different than Antônio Eduardo Pesaro in some of its aspects. In this context, the search for a single cause of aging has recently been Geriatrics and Physiatry; Catholic those in men. In addition, pathology and pathophysiology of the disease present significant UniversityCarlos V of SerranoSacred Heart, Jr Rome, replaced by the view of aging as an extremely complex, multifactorial process. Therefore, the gender differences, which leads to difficulties concerning diagnosis, treatment and outcome of the Italy; 2Department of Aging and different theories of aging should not be considered as mutually exclusive, but complementary GeriatricHeart Institute Research, (InCor), College University of female population. The reason for this disparity is all steps for female cardiovascular disease of São Paulo, School of Medicine, of others in the explanation of some or all the features of the normal aging process. To date, no Medicine, Institute on Aging, evaluation, treatment and prevention are not well elucidated; and an area for future research. This UniversityBrazil of Florida, Gainesville, FL, convincing evidence showing the administration of existing “anti-aging” remedies can slow aging review brings together the most recent studies published in the field of coronary artery disease USA or increase longevity in humans is available. Nevertheless, several studies on animal models in women and points out new directions for future investigation on some of the important issues. have shown that aging rates and life expectancy can be modifi ed. The present review provides Keywords: coronary artery disease, women, risk factors, prevention, diagnosis, treatment. an overlook of the most commonly accepted theories of aging, providing current evidence of those interventions aimed at modifying the aging process. Keywords:Introduction Aging, anti-aging medicine, caloric restriction, oxidative damage, infl ammation, physical exercise The first female-specific recommendations for preventive cardiology were published in 1999 (Mosca et al 1999). Even though research in the treatment of cardiovascular disease Introduction(CVD) had advanced in many areas, it remains the leading cause of death in women in Agingmost parts is commonly of the world. defi Studies ned as thehave accumulation shown that 500 of diversethousand deleterious women die changes of CVD occur- every ringyear inin cellsthe Unitedand tissues States, with somewhat advancing near age one that death are responsible every minute for the(American increased Heart risk ofAssociation disease and 2003). death Such (Harman index exceeds 2003). Thenot only observation the number that of most deaths of inthe men, animals but also living the innext a natural seven causesenvironment of death rarely in women becomes combined, senescent and (because more importantly, dying earlier coronary for predation, artery disease,disease (CAD) starvation, is believed or drought) to be the(Holliday major cause 2006) responsible suggests that for agingthese deathsis a phenomenon (American uniqueHeart Association to the human 2003). species Over (Hayfl a quarter ick of 2000b). a million In deathsother words, per year the are advancing attributed toknowl- CAD edgealone ofin hygienethe United and States biomedicine (Merz et has al led2004). us to Although discover already the aging high, process, these figuressomething are thatexpected was teleologicallyto rise even more not duringintended the for next us decades, to be experienced due to an increase (Hayfl ick of 2000b).diabetes Theand immediateobesity, as well consequence as the aging of ofthe the extended world population life expectancy (Merz iset represented al 2004). by the increas- ing Evennumber though of older women people have in adeveloped higher frequency countries, of an chest artefact pain/angina of human than civilization men, the (Hayflincidence ick 1998,of obstructive 2000a). CAD in the female population is lower when compared with menLife with expectancy similar symptoms is defi ned (Kenedy as the average et al 1982; total Diamond number et of al years 1983; that Merz a human et al 1999). expects In toaddition, live. Differently, it would appearlife span that is theyoung maximum women number with obstructive of years that CAD a human have cana worse live. Whileprognosis the humanafter acute life spanmyocardial has substantially infarction remained(AMI), whereas unchanged older for women the past in 100,000 similar yearscircumstances at ~125 years,often present life expectancy with larger has number sensibly of comorbidities increased (~27 that years adversely during influence the last Correspondence: Matteo Cesari century),the outcome, especially when compared in Western to men Countries (Coronado (Hayfl et alick 1997). 2000b). Women The withlengthening acute coronary of life Department of Gerontology, Geriatrics expectancysyndromes (ACS) is mainly are alsodue toless the likely elimination to receive of rapid most effective infectious diagnosis diseases and occurring treatment in and Physiatry; Catholic University of SacredCorrespondence: Heart; Largo Carlos F. Vito, V 1; Serrano 00186 Jr youth,than arebetter men hygiene, (Ayanian and the and adoption Epstein of antibiotics 1991; Maynard and vaccines. et al 1996; Pope Rome,Coronary Italy Care Unit, Av. Dr. Enéas et alBefore 2000). examining the hypothesized biological factors at the basis of the aging Carvalho Aguiar, 44 – sala 12 – bloco 2, Tel +39 06 3015 4341 process, it is crucial to underline that aging is not a disease. Based on this assump- FaxSão +39Paulo 06 -3051-911 SP - 05403-900, Brazil Regarding the North American population, the Women’s Ischemic Syndrome EmailTel +55 [email protected] 11 3069 5058 tion,Evaluation Hayfl ick (WISE) estimates study that workshop a potential (Hayes cure et of al the 2004; leading Maseri causes 2004; of Nabel death etin al old 2004; age Fax +55 11 3088 3809 Email [email protected] Pepine et al 2004; Shaw et al 2004; Waters et al 2004) from the National Heart, Lung and ClinicalVascular Interventions Health and in AgingRisk 2007:2(3)Management 401–412 2006:2(4) 465–475 401465 © 20072006 Dove Dove Medical Medical Press Press Limited. Limited. All rights All rightsreserved reserved Tosato et al REVIEW (ie, cardiovascular disease, stroke, cancer) would only lead intervention in the aging process has been achieved in any to a 15 year-increase in human life expectancy (Hayfl ick other life form in view of the absence of a generally accepted 2000b). Therefore, even in this hypothetical condition, we defi nition of aging and prec markers to measure its rate of will not become immortal, but we will only be able to expe- change (Hayfl ick 2004). Nevertheless, several studies on ani- rienceCoronary how death occurs in the absenceartery of disease. disease Because mal models in havewomen: shown that aging ratesa reviewand life expectancy aging is negatively associated with the ability to respond to can be modifi ed. stresson and positively prevention, related to the homeostatic pathophysiology, balance and diagnosis, and incidence of pathology, death remains the ultimate conse- Evolutionary theory of aging quencetreatment of aging (Kowald and Kirkwood 1996). Evolutionary theory indicates aging as the result from a decline Author copy only The notion that aging requires treatment is based on the in the force of natural selection. This theory was fi rst extensively belief that becoming old is undesirable. In the last decades, formulated in the Forties from the observation of patients with agingLeila has Fernandesreceived a negative Araujo connotationAbstract: and become Despite numerousHuntington’s studies on disease, women’s a cardiacdominant health lethal throughout mutation the past(Haldane decade, the synonymousAlexandre of deterioration, de Matos Soeiroapproachingnumber pathology, of female and deaths 1941). caused Itby was cardiovascular noted that, disease even if still subjects rises and affected remains by the this leading con- cause of death in women in most areas of the world. Novel studies have demonstrated that cardiovascular death.Juliano If our society Lara wouldFernandes learn to value old age to the same dition should be strongly selected, the Huntington’s disease disease, and more specifically coronary artery disease presentations in women,