Current Landscapes of Cardiovascular Care in an Ageing Population
Population ageing and the rise in age-related cardiovascular disease (CVD) pose significant challenges for healthcare systems, society and the economy worldwide.1 CVDs continue to be the leading cause of death and illness among older adults globally.1 In the US, the number of adults aged 65 and older is projected to increase from 58 million in 2022 to 82 million by 2050, raising their population share from 17% to 23%.2 Healthcare expenses for older adults with frailty are reported to be approximately five times higher than those for non-frail adults.3 In 2020, one in three adults in the US received care for a cardiovascular risk factor or condition.4 The projected annual healthcare costs for cardiovascular risk factors are expected to triple between 2020 and 2050, rising from US$400 billion to US$1.344 trillion (in 2022). For cardiovascular conditions, annual healthcare costs are anticipated to nearly quadruple, increasing from US$393 billion to US$1.49 trillion.4 Furthermore, related productivity losses are projected to increase by 54%, from US$234 billion to US$361 billion. In Singapore, about one in four citizens is expected to be over 65 years of age by 2023. It is estimated that 83,000 older individuals will be living alone and around 100,000 will have mild disabilities, defined as impairments in at least one activity of daily living. The annual expenditure for elderly healthcare is estimated to rise tenfold, reaching approximately US$49 billion by 2030.5–7 These increases will place substantial strains on government budgets, infrastructure and the savings of older adults and their families.
With ageing, physiological changes occur in nearly all organ systems.8 Ageing is the primary risk factor for many prevalent diseases in developed countries, including cancer, CVD, neurodegenerative diseases and musculoskeletal disorders.9 In particular, ageing is the leading risk factor for CVD.10 The decline of other organ systems often occurs alongside the onset of CVD and is associated with loss of functional independence, reduced mobility, depressive moods and frailty.11 Importantly, these changes do not function in isolation; they interact with one another, complicating care provision for older adults. Multimorbidity, which is the presence of multiple chronic health conditions, affects more than two-thirds of older individuals and the majority of patients with chronic CVD.12 Patients with multimorbidity tend to experience high resource usage, poor mobility and worsening health statuses, which in turn increase their risk of death.12
Managing patients with chronic CVD and multimorbidity imposes several challenges for care provision and these complexities can complicate decision-making and lead to fragmented care.13 In cardiology, where many invasive treatments are available, assessing frailty and functional disability and patient-centred shared decision-making are crucial steps in determining the appropriateness of these interventions.14 When patients are experiencing substantial impairments in their quality of life and independence, discussing their health priorities and adjusting treatment plans accordingly becomes essential.14 Therefore, the approach to older patients with CVD requires a comprehensive, multidisciplinary and individualised strategy that diverges from the traditional disease-based models of care.14
Gaps in Gerontology within Cardiology
Under-representation
Despite the growing global ageing population, older adults remain significantly under-represented in clinical research and trials related to diseases that primarily affect them, including CVDs.15 Individuals aged 75 and older are disproportionately under-represented in clinical trials, often due to age-related multimorbidity and frailty, even though they are at higher risk for adverse disease outcomes.16 Arbitrary age limits and other criteria, including the presence of comorbidities, organ dysfunction, polypharmacy, physical or cognitive impairments and reduced life expectancy, often curtail their recruitment into trials.17 The exclusion of older adults has created critical gaps in evidence regarding the real-world efficacy and safety of treatments.18 Considerations around drug–disease and drug–drug interactions and disease-specific pharmacokinetics are increasingly important in older individuals with multimorbidity and polypharmacy. It is estimated that participants in randomised controlled trials are, on average, 20 years younger than those in large observational studies.19 Consequently, clinical guidelines often provide recommendations for older adults that are less robust than those for the younger populations.20 This discrepancy typically arises from insufficient data or results from observational studies. As a result, when new medications become available for clinical use, prescribers may lack sufficient information to safely prescribe these treatments for older patients, limiting accessibility for this demographic.19
Gaps in Geroscience
Geroscience is a research field based on the hypothesis that interventions aimed at slowing or reversing the molecular drivers of ageing could simultaneously delay functional decline and the onset of various age-related diseases.21 The geroscience hypothesis suggests that by addressing the molecular damage associated with ageing, we may be able to extend health expectancy, offering hope that the growth of morbidity could be halted or even reversed despite existing demographic trends.22 However, the application of these interventions, such as senotherapeutics or mitochondrial therapies, has not been sufficiently specific and has been curtailed by off-target adverse effects.23 Additionally, systemic biomarkers currently lack the precision needed to accurately pinpoint cardiovascular senescence, while conventional cardiovascular imaging methods primarily detect structural changes associated with irreversible advanced disease stages.24
Several key questions regarding ageing biomarkers need to be addressed. Specifically, we need to understand how these biomarkers can reliably track longitudinal changes in biological ageing, demonstrate their response to interventions and show how biomarkers accurately reflect health or functional status variations.22,25 This information is crucial for illustrating how biomarkers of ageing can be used to evaluate the effectiveness of gerotherapeutics.26 Moreover, to realise the translational potential of geroscience in enhancing healthy longevity, we will focus on fulfilling two conditions: first, developing measures of biological ageing that can predict significant clinical outcomes through algorithms incorporating a wide variety of biomarkers; second, developing interventions capable of slowing the pace of biological ageing.22 Our goal is to establish effective biomarkers that are validated in humans and have the potential for routine clinical use.
Cardiovascular Ageing at the Intersection of Systemic Conditions and Cardiovascular Outcomes
The biological ageing process is fundamental to the development of various age-related diseases, including CVD, cancer, neurodegenerative diseases, insulin resistance and autoimmunity.27 It follows that individuals with CVD may be more susceptible to these diseases due to the effects of underlying biological ageing. Indeed, both CVD and cancer share numerous common risk factors and have a bidirectional relationship, where individuals with CVD are at a higher risk of developing cancer.28 Intervention strategies aimed at key pathways involved in biological ageing may hold great promise for preventing multiple age-related diseases.27
In the example of cardio-oncology, biological ageing plays a crucial role in tumorigenesis, creating a complex relationship among the fields of gerontology, CVD and oncology (a ‘gero-cardio-oncology’ trisection).29 Effective cancer treatments can exacerbate the hallmarks of biological ageing, increasing the risk of cardiotoxicity associated with these therapies. These adverse effects can manifest either directly (e.g. heart failure [HF] or myocarditis) or indirectly through the development of de novo CVD later in life among survivors.30,31 Older patients, who often have risk factors common to both cardiotoxicity and CVD (e.g. diabetes, obesity and dyslipidaemia), are particularly vulnerable to developing treatment-related cardiotoxicity.32 Currently, there is a lack of robust data identifying individuals at risk of cardiotoxicity, as well as effective strategies for prevention.33 Continued basic and translational research in geroscience is essential for deepening our understanding of the underlying mechanisms and developing strategies that address the intersections of cardiovascular ageing, gerontology, cancer, CVD and other age-associated conditions. Recent investigations into the links between CVD and ageing-related cellular processes, such as autophagy and senescence, are beginning to provide valuable insights that may lead to future innovative therapeutic strategies.34
Research Focus Areas
Frailty, Ageing-related Health and Functional Outcomes
Healthy ageing emphasises the importance of developing and maintaining functional ability, which contributes to overall wellbeing in older age, rather than simply focusing on the absence of disease.35 This concept encompasses performing tasks and engaging in daily life activities. Early identification of functional decline is essential for older adults to age healthily and maintain a good quality of life. An older person’s functional status is closely linked to accompanying comorbidities and chronic diseases, which often contribute to physical limitations.36 Older adults prioritise functional outcomes across various aspects of life.37 While many studies focus on hard outcomes like mortality, fewer clinical trials investigate outcomes that older adults value, such as quality of life, functional maintenance and independence.38 Researchers, clinicians and policymakers should consider these factors when performing studies and implementing care for older patients.
The Healthspan–Lifespan Gap and Longevity Science
Life expectancy has increased by three decades since the 20th century;39 however, the expansion of healthspan – the period of life spent in good health and enjoying a high quality of life – has not kept pace.40 This disparity has primarily been due to the rising prevalence of chronic diseases afflicting an ageing population.39 There is a recognised gap of approximately 9 years between lifespan and healthspan as indicated by health-adjusted life expectancy, which considers life expectancy, years lived with disability and premature death from disease.39
With advancing age, the time between the emergence of competing diseases shortens.41 When the risk of death from certain diseases, such as cancer or MI, decreases, the risk of death or disability from other diseases becomes more pronounced.41 The danger lies not in one disease replacing another but in the fact that new diseases tend to be more debilitating.41 According to estimates from the UN, more than 40% of individuals aged 60 and older live with some form of disability, with more than 250 million experiencing moderate to severe disability.42 Chronic diseases are responsible for 79% of all years lived with a disability; specifically, four major non-communicable diseases – CVDs, cancers, chronic respiratory diseases and diabetes – are the leading causes of disability and death in the US. 39,43 Other non-communicable diseases, including musculoskeletal disorders, depression and dementia, also contribute significantly.44 Among the older population, the most common causes of functional disability are dementia, orthopaedic diseases and stroke.45 Vascular dementia is more common in men, whereas Alzheimer’s disease is more prevalent in women. Ischaemic strokes are more frequent among men than women, while the rates of fractures and arthritis are notably higher among women. Extending lifespan alone without delaying the onset of diseases or reducing their severity could worsen the gap between healthspan and lifespan.39 Adding years to life without improving the quality of life may not be in the best interests of the ageing population.46 This evolving paradigm has generated interest in clinical trials designed to find meaningful ways to extend the quantity and quality of life for older adults.46
Alongside disability, age-related outcomes are significantly worsened by frailty, which is the decline in multiple body systems that leads to increased vulnerability. Frailty syndromes affect approximately 25% of individuals over 80 years of age.39 Yet, they are often under-recognised despite contributing to poor quality of life, increased disability, falls, hospitalisation, long-term care needs and higher mortality.39 In long-lived populations, a substantial portion of lifespan and most deaths occur during a period when the risk of frailty and disability grows exponentially.41 During this period, it becomes increasingly challenging to intervene using conventional disease-focused interventions,41 and diseases become more resistant to treatment.47 Moreover, frailty has become increasingly more common among younger age groups.39 Poor lifestyle choices can exacerbate frailty, with a disproportionate impact on individuals with lower socioeconomic status and, particularly, women, limiting their access to equitable healthcare.39 Therefore, applying longevity science to develop effective and equitable preventive measures against age-related diseases is critically important.
There is a strong theoretical basis suggesting that the onset of functional disability is driven by physiological changes associated with ageing and underlying chronic diseases.43 This notion is supported by previous studies that demonstrate significant correlations between the increased incidence of functional disability and chronic diseases, such as diabetes, stroke and heart disease, among older individuals.43 Longevity research takes a multidisciplinary scientific approach to understand the mechanisms of ageing, identify potential interventions and develop novel strategies to promote longevity and delay, prevent or reverse age-related disease.40 Some promising agents have emerged in the search for anti-ageing drugs, among which rapamycin, metformin and senolytics are particularly noteworthy.46 However, more research is required to establish their long-term safety and efficacy. Many senolytics were repurposed from other treatments and they may have unforeseen side-effects with prolonged use.48 Additionally, the impact of senolytics on the immune system and their potential to interfere with other physiological cellular processes, such as wound healing and cancer defence, warrant further investigation. More research is essential to assess the long-term safety and efficacy of medications, particularly in human subjects.49,50
To improve healthspan and longevity, a comprehensive and multidisciplinary public health response is essential for addressing the causes and consequences of ageing.40 Such an approach should encompass various factors, including physiological aspects, cellular mechanisms, translation and clinical interventions on enhanced diagnostic and therapeutic technologies and access to clinical delivery.40 Furthermore, it should address broader societal implications by integrating lifestyle and social interventions to mitigate age-related decline and encourage healthy ageing. By prioritising healthspan, these interventions may also extend lifespan.40 A healthy body, free from chronic disease or disability, typically functions better and longer. While the bulk of the ageing population will invariably encounter an age-related disease such as CVD at some point in their lifespan, the ability to survive and recover to baseline functional status, termed biological resilience, through purposeful secondary prevention, would be critical.51
Despite its potential, longevity medicine faces several significant limitations as a developing field.40 First, there is uncertainty regarding the classification of ageing. There is no widely accepted consensus on when age-related functional decline should be considered pathological.52 This ambiguity complicates efforts to secure funding and grants for longevity research. Additionally, whether ageing should be classified as a disease or a natural process remains unclear.53 Second, there are time constraints in clinical studies. Due to the extended time required to observe effects, clinical studies cannot feasibly use lifespan as a primary outcome measure.25 Consequently, surrogate biomarkers of lifespan or healthspan are necessary for advancing human trials in longevity research. Third, current biomedical research and clinical practices have their limitations. Biomedical research relies on statistical correlations and population averages, while clinical practices often focus more on treating diseases than maintaining health. Shifting towards personalised medicine that considers individual variation is crucial, as no one truly represents an average.40 By addressing these challenges and deepening our understanding of the ageing process, we can pave the way for advancements in longevity research and the development of effective interventions that promote healthy ageing and extend human lifespan.
Geriatric Cardio-oncology Intersection
Cancer and CVD are the two leading causes of death globally.54 The burden of cancer is increasing rapidly due to population ageing, population growth and changes in exposure to risk factors.55 Since ageing, CVD and cancer share common risk factors and overlapping biological mechanisms, older individuals with CVD are at an even higher risk of developing cancer; this has led to a significant shift in the causes of death among patients with CVD, moving from primarily cardiac-related deaths to non-cardiac-related deaths, including cancer.56,57 Moreover, cancer treatments can cause cellular damage and contribute to accelerating biological ageing.58 Chemotherapy and radiotherapy affect crucial mechanisms that influence signalling pathways that regulate biological ageing.58 Consequently, older adults undergoing cancer therapy are even more vulnerable to developing cardiovascular issues (e.g. HF, myocarditis and atherosclerosis).59 The occurrence of cardiotoxicity can lead to the discontinuation of cancer treatment and an increased risk of frailty.59 Currently, there are few effective preventive or treatment strategies available for most cancer therapy-related cardiotoxicities, highlighting the need for translational research to identify clinically relevant interventions.60
Sex-based Differences in Cardiovascular Ageing and Outcomes
Understanding the sex-specific patterns of cardiac and vascular ageing is essential for understanding the differences in cardiovascular risk and identifying preventive strategies that could benefit both men and women.60 The differences in cardiovascular ageing phenotypes begin early in life and tend to accelerate with age.61 Age-related cardiac remodelling affects women and men differently, contributing to a higher prevalence of HF with preserved ejection fraction (HFpEF)in women compared to men.62 As they age, women often experience an earlier onset of left ventricular (LV) stiffness and a greater tendency for concentric LV remodelling, increased LV thickness and more severe diastolic dysfunction.62 Recent evidence indicates that metabolic diseases, such as obesity and diabetes mellitus, tend to disproportionately affect older women compared to men in the context of HF, which may help explain the differences in HF outcomes between the sexes.63 Consequently, older women are more likely than men to develop HF with ageing.64 Following an HF hospitalisation, women have a higher risk of rehospitalisation and face significantly greater premature mortality than men.65 While survival rates may be comparably poor for both sexes, women often experience more debilitating HF symptoms.66 Additionally, women respond differently to HF medications than men and are more susceptible to adverse drug effects, complicating their treatment.67 There are also fewer effective therapies available for HFpEF, the predominant phenotype among women, which exacerbates the disparities in HF outcomes and limits opportunities to mitigate HF risk.68 Investigating the sex differences in cardiovascular ageing provides a chance to examine the structural and functional changes predisposing older women to HF and identify potential upstream targets to slow ageing and improve outcomes for both sexes.
Regenerative Cardiovascular Medicine
Regenerative medicine aims to restore the function of damaged tissues and organs due to disease, injury, or ageing by repairing, regenerating, or replacing them.69 The heart has a limited ability to regenerate, so when damage occurs, tissues are often replaced primarily by collagen scars, which have significantly different biophysical properties compared to the original cardiac tissue.70 Depending on the extent of the damage, scar tissue can impair heart function and induce life-threatening arrhythmias and aneurysms.70 Regenerative cardiology focuses on repairing or regenerating damaged heart tissue through cell therapy, gene therapy and tissue engineering techniques. The goal is to restore normal function and address the heart’s limited regenerative capacity.
There have been several advances in regenerative cardiology over the past decade. A significant milestone in regenerative medicine was the discovery of induced pluripotent stem cells (iPS cells), which have properties similar to embryonic stem cells.71 This groundbreaking achievement enables the potential use of any cell to generate unlimited numbers of differentiated cells without relying on embryonic stem cells.72 Since its transformative discovery, iPS technology has enabled the routine creation of human cardiomyocytes from iPS cells derived from human fibroblasts.73 This therapeutic approach may also involve regenerative surgery, the transplantation of immature progenitor cells and microdevices within the damaged heart. These interventions are expected to promote the formation of new blood vessels and cardiac muscle cells.70
A surge of scientific interest in regenerative surgery has led to numerous clinical trials.70 There are also ongoing explorations into cellular regenerative therapies that use various stem cells to enhance the heart’s functional recovery, primarily through cytokine paracrine effects.74 Another promising field is drug-induced regenerative therapy, which stimulates the body’s self-endogenous regenerative systems without the need for invasive methods or cell cultures, thus overcoming the limitations of cellular therapies.74 However, there are still many challenges in transforming chemical leads into regenerative medicine drugs. The effectiveness of a compound in vitro does not necessarily predict how it will perform in vivo and continued research efforts are needed.75 The field of regenerative medicine combines advanced technologies, including cell therapy, tissue engineering, gene therapy, bioprinting and biomaterials.76 Consequently, cardiovascular regeneration requires the coordinated efforts of scientists and clinicians with different expertise, encompassing cell biology, engineering, material science, mathematical modelling, cardiology and vascular surgery.70
Gerontechnology and Artificial Intelligence
The demand for digital health technologies has increased significantly, especially during the recent COVID-19 pandemic.77 Digital health technologies – including telehealth, telemedicine, mobile health and remote patient monitoring – have played a crucial role in cardiovascular care provision by overcoming various obstacles, including transportation issues, limited geographic access, a lack of community-based programmes and insufficient staffing.78 Recently, wearable monitoring technologies such as biopotential-specific ECGs, accelerometers for motion detection and environmental sensory units that track temperature, heart rate and pulse, have been rapidly adopted.78 However, adapting these digital health tools for ageing populations presents unique difficulties.79 Identifying and selecting tools that have demonstrated proven, evidence-based efficacy for older adults remains an ongoing challenge.80 Additional research and effort are urgently needed in these areas.
Population Health, Cardiovascular Prevention and Cardiovascular Longevity
Despite numerous groundbreaking advances in disease therapy, CVD remains the leading cause of global mortality, accounting for approximately 20.5 million deaths annually.81 Alarmingly, up to 80% of these CVDs are potentially preventable through lifestyle changes and by addressing key risk factors.82 Maintaining cardiovascular health is crucial at every stage of life and early life influences can lead to better long-term health outcomes.83 Unfavourable metabolic profiles in childhood, such as obesity, high blood pressure, elevated triglycerides and lower HDL cholesterol, predicted accelerated biological ageing as measured by epigenetic age by midlife.84 Additionally, poor lifestyle choices are associated with abnormal DNA methylation patterns and an increased risk of CVD and cardiovascular mortality.85 These metabolic factors are also linked to subclinical atherosclerosis, forming a lasting metabolic legacy that can persist from young adulthood into older age.86
In line with the global commitment to reducing the burden of CVD, researchers and policymakers should strive to promote population health, support cardiovascular prevention initiatives and encourage healthy longevity. It is imperative to address the escalating incidence rates of CVD, diabetes, cancer, respiratory illnesses, kidney diseases and obesity in many countries.87 Innovative strategies are crucial for preventing and treating major non-communicable diseases to achieve the UN’s Sustainable Development Goals and improve human life expectancy.
Challenges in Addressing Cardiovascular Ageing in the Asia-Pacific
Socioeconomic disparities significantly affect many Asian countries, with income inequality varying widely.88 Many Asian countries report low rates of screening for cardiovascular risk factors and many lack structured screening programmes, relying instead on decentralised, community-led efforts.89 Additionally, high rates of medication nonadherence are common, with figures ranging from 40% to 80%.90 In socioeconomically disadvantaged and indigenous communities, the prevalence of frailty can exceed 50%; however, this prevalence is likely underestimated due to a high number of non-responses in population health surveys involving older adults. The healthcare costs associated with frailty are particularly concerning in the Asia-Pacific region, where older adults with high healthcare needs often struggle to access publicly funded healthcare services.91,92 Implementational strategies that differ from modern healthcare models may be necessary to address frailty in this region effectively.93
Within the Asia-Pacific cardiology community, a comprehensive institute dedicated to discovering, translating and implementing scientifically backed strategies for older adults combating cardiovascular ageing is urgently needed. This should encompass a broad spectrum of approaches, from primary prevention at the population health level to secondary prevention and maintenance of healthy longevity among older adults with CVD.
Call to Action: Advancing Cardiovascular Science in Ageing
Clinical Care and Implementation
The growing awareness of frailty has sparked a surge in frailty research; however, effective implementation strategies for reducing frailty within cardiology are lacking.14 The practical application of frailty measures in clinical practice has remained challenging, hindered by unclear consensus on frailty definitions, selecting appropriate assessment tools and ambiguity surrounding the necessary actions once frailty individuals are identified.14,93 A recent survey of cardiologists revealed a widespread knowledge gap and inadequate practices regarding frailty management.93 Alarmingly, over half of the surveyed cardiologists admitted to never or rarely screening older patients for frailty before invasive procedures or during acute episodes of CVD. The survey underscored significant deficiencies and highlighted the need for actionable strategies in managing frail older adults with CVD. Identifying specific challenges unique to stakeholders in cardiology may be key to reducing implementation barriers and minimising frailty care fragmentation.
Proactive steps are essential for addressing the implementation challenges of frailty prevention and improving patient outcomes. It is necessary to cultivate awareness and education among healthcare professionals to ensure that cardiology providers – including nurses, therapists and physicians – are equipped with the required knowledge and skills to recognise and treat frailty effectively. Collaborations between interdisciplinary stakeholders will help eliminate barriers and streamline care efficiently. Implementing standardised protocols for frailty screening, especially before invasive procedures and acute episodes of CVD, may lead to better clinical outcomes. Furthermore, we must advocate for new initiatives and research aimed at developing practical tools for frailty assessment and intervention strategies. By committing to these steps, we can significantly enhance the care of frail older adults with CVD by ensuring they receive comprehensive care.
Education and Training
Studies have highlighted critical gaps in knowledge concerning ageing and frailty among clinicians who lack specialised expertise in geriatric care.94 Our multinational survey of cardiologists revealed that while many acknowledged the vital importance of frailty, they were largely unaware of the effective management strategies or steps to implement them.93 Another national cross-sectional study among health professionals in Australia revealed that only 14% of respondents received specific training on frailty, with most learning occurring “on the job” or as part of broader training programmes.94 The feedback from programme participants indicated a strong desire for active learning methods that prioritise practical clinical skills over theoretical knowledge. However, most frailty education programmes have primarily focused on raising awareness of frailty rather than on in-depth training on management strategies.95 The enthusiasm of the participants suggests that we can effectively address these educational barriers with focused efforts.
We should adopt a more proactive training approach to ensure clinicians are equipped with the fundamental geriatric cardiology principles.34 By incorporating these precepts into the standards of cardiology fellowship training (e.g. Core Cardiology Training Symposium and European Exam in Core Cardiology), we can better prepare future cardiologists to tackle the complexities of caring for older patients.34 Furthermore, there is a need to develop leaders in geriatric cardiology across all cardiology subspecialties to ensure quality care for our ageing population.96 While there is a growing recognition of the need for enhanced geriatric-centred training and education, decisive and positive action is necessary to establish the optimal approach for implementing this training and to elevate the standard of care for older patients.94
Collaborations and Partnerships
Collaboration among gerontologists, cardiologists and various other specialists is essential to address the unique needs of the growing population of older adults.34 To successfully manage frailty in our communities, we must actively build partnerships among healthcare professionals, allied health staff (e.g. nursing, social workers, case managers, dietitians, physiotherapists, exercise physiologists and trainers) and the broader social community network. Effective interventions for these vulnerable individuals require collaborative partnerships, including interdisciplinary care for high-risk individuals, facilitating skilled advanced care planning, ensuring reliable access to treatment and fostering strong relationships with primary care providers.97 Furthermore, by actively involving patients and engaging their families, older adults can be empowered to live independently within their communities. This collaborative approach enhances seniors’ wellbeing and strengthens our societal resilience in combating frailty.
Global and Regional Partnerships
A concerted global effort is essential to collect longitudinal health data to address the under-representation and the lack of real-world data for older adults in research.18 International collaborations, such as the GLOB-cAGE Consortium, are crucial in uniting cohorts of older individuals worldwide, fostering a deeper understanding of ageing-related CVD.18 By harmonising non-identifiable data from longitudinal cohorts focused on cardiometabolic health and progression of CVD, we can generate comprehensive results with greater statistical power, such as comparisons of cardiovascular care delivery and outcomes among older individuals across different geographical regions, demographics and sociocultural groups, which will produce impactful outcomes.98 Furthermore, it will enable a detailed examination of the real-world impacts of ageing-related issues, such as multimorbidity and frailty, which reflect clinical practice.98 This approach will support rigorous cross-national scientific research and inform policy discussions.81 By investing in large multinational longitudinal cohorts, we can explore the implications of CVDs on other ageing-related diseases, including frailty, sarcopenia, cognition and mental health disorders, ensuring that research reflects the realities faced by older adults and supports their health and wellbeing.
Conclusion
Population ageing is the dominant and pervasive global demographic trend, driven by increased longevity, declining birth rates and the progression of large cohorts into older age groups. As a result, older adults are experiencing higher rates of multiple chronic diseases and increased healthcare usage. The presence of various age-related cardiovascular and non-cardiovascular conditions adds to the complexity of care, along with declines in other health aspects, such as cognition and physical function, and the weakening of social support systems. Consequently, the burdens of care have risen significantly. There is an urgent need to prioritise ageing care within cardiovascular medicine. Addressing the significant gaps and disparities in translational and implementational research is crucial. Establishing effective clinical and policy frameworks while supporting healthcare providers through education, training and cross-disciplinary collaboration is a key strategy for combating the impact of population ageing. Building global and regional partnerships will create platforms for real-world data and enhance statistical power to study under-represented groups. Developing innovative care models and emphasising real-world translation will significantly transform how we address the challenges of cardiovascular ageing.
Clinical Perspective
- Population ageing and the rise in age-related cardiovascular disease (CVD) pose significant challenges for healthcare systems and economies globally. More than two-thirds of older adults experience multimorbidity, which complicates their care due to loss of independence, reduced mobility and frailty.
- To effectively treat older patients with CVD, comprehensive individualised approaches beyond traditional models are needed. Despite recent progress in gerontology and cardiovascular research, more work is necessary in clinical care, education and health policy.
- Centralised institutions focused on developing and implementing scientifically backed strategies are urgently needed to address these challenges.
- We propose a cardiovascular ageing and longevity initiative, the first of its kind in the Asia-Pacific region, focused on advancing geriatric cardiology through cardiovascular geroscience and gerontechnology.