Vascular disease in the older adult

Among older adults, incidence and prevalence of aortic disease, peripheral arterial disease (PAD), and venous thromboembolism (VTE) increase as age-related alterations in vascular structure and function are compounded by longer exposure to cardiovascular disease (CVD) risk factors. This review highlights the unique presentations and treatment strategies for aortic dissection, abdominal aortic aneurysm (AAA), PAD, and VTE in older adults. Dai, et al. described some of the distinctive physiologic aspects of cardiovascular aging. Arterial changes include: increased calcium deposition, collagen content and collagen cross-linking; increased vessel diameter and outward remodeling; increased reactive oxygen species and a pro-inflammatory state; and increased apoptosis of vascular smooth muscle cells. Other changes include: alterations in endothelial function, neurohormonal regulation and renal function; and venous stasis with laxity in large venous valves. The cumulative impact of these vascular processes lead to unique physiology and vulnerabilities of older adults, which are commonly manifest in target organ damage and vascular disease.