Vascular pathology and its associated clinical entities have a broad impact on the health of older persons. Specifically, cardiovasculardisease and stroke account for the majority of morbidity and mortality in individuals over the age of 65 (1). Other conditions related to vascular pathology, such as erectile dysfunction (ED) and impaired wound healing, also have a significant effect on the lives of older persons. Understanding the changes in the vasculature that occur with aging may provide insights into many disorders that affect the elderly.

Aging is associated with multiple changes in endothelial cell (EC) function that limit the capacity of older blood vessels to dynamically regulate and restore blood flow (Table 152–1). Although older persons have higher vascular risk factor profiles as a result of cumulative environmental exposures (e.g., smoking) and an increased prevalence of endogenous pathological conditions (e.g., diabetes and hyperlipidemia), inherent age-related changes in endothelial function contribute significantly to subsequent vascular dysfunction. Accordingly, it is important to emphasize that, although many factors have a role in the development of EC dysfunction, the normal aging process is itself an independent risk factor for developing vascular diseases. The overall goal of this chapter is to focus on changes in endothelial function related to “normal” aging in the general population, and to discuss the interaction between aging and other cardiovascular risk factors in promoting vascular disease in the elderly.

THE AGED ENDOTHELIAL CELL

Little is known about how “normal aging” affects ECs in the absence of disease and/or age-related physiologic changes impacting vascular and endothelial function. Many of the observations are extrapolated from experiments using fibroblasts that have incurred numerous population doublings in vitro (2,3).