Healthy aging and myocardium: A complicated process with various effects in cardiac structure and physiology

•Cardiac aging is characterized by a series of complex pathophysiological events.•Age-related changes make the aged myocardium more susceptible to disease.•We summarize the entire data concerning the multilevel changes in aged myocardium.•We present the recent evidence for the pathophysiological basis of cardiac aging.•Novel therapies targeting specific mechanisms may delay cardiac aging in future.

It is known that there is an ongoing increase in life expectancy worldwide, especially in the population older than 65 years of age. Cardiac aging is characterized by a series of complex pathophysiological changes affecting myocardium at structural, cellular, molecular and functional levels. These changes make the aged myocardium more susceptible to stress, leading to a high prevalence of cardiovascular diseases (heart failure, atrial fibrillation, left ventricular hypertrophy, coronary artery disease) in the elderly population. The aging process is genetically programmed but modified by environmental influences, so that the rate of aging can vary widely among people. We summarized the entire data concerning all the multifactorial changes in aged myocardium and highlighting the recent evidence for the pathophysiological basis of cardiac aging. Keeping an eye on the clinical side, this review will explore the potential implications of the age-related changes in the clinical management and on novel therapeutic strategies potentially deriving from the scientific knowledge currently acquired on cardiac aging process.