Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty

Aug 2, 2018Nature reviews. Cardiology

Chronic Inflammation in Ageing, Heart Disease, and Frailty

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Abstract

Most older individuals develop inflammageing, characterized by elevated blood inflammatory markers linked to chronic morbidity and premature death.

Inflammageing is associated with increased susceptibility to chronic conditions such as cardiovascular diseases, chronic kidney disease, diabetes, cancer, depression, dementia, and sarcopenia.
Potential mechanisms contributing to inflammageing include genetic factors, central obesity, changes in gut health, and immune system dysregulation.
The relationship between inflammation and cardiovascular diseases is suggested to be causal based on clinical trial evidence.
The impact of inflammation on non-cardiovascular health issues remains uncertain and requires further investigation.
There is a need for clinical trials to test if early intervention in inflammageing can prevent or delay cardiovascular frailty.

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Most older individuals develop inflammageing, a condition characterized by elevated levels of blood inflammatory markers that carries high susceptibility to chronic morbidity, disability, frailty, and premature death. Potential mechanisms of inflammageing include genetic susceptibility, central obesity, increased gut permeability, changes to microbiota composition, cellular senescence, NLRP3 inflammasome activation, oxidative stress caused by dysfunctional mitochondria, immune cell dysregulation, and chronic infections. Inflammageing is a risk factor for cardiovascular diseases (CVDs), and clinical trials suggest that this association is causal. Inflammageing is also a risk factor for chronic kidney disease, diabetes mellitus, cancer, depression, dementia, and sarcopenia, but whether modulating inflammation beneficially affects the clinical course of non-CVD health problems is controversial. This uncertainty is an important issue to address because older patients with CVD are often affected by multimorbidity and frailty - which affect clinical manifestations, prognosis, and response to treatment - and are associated with inflammation by mechanisms similar to those in CVD. The hypothesis that inflammation affects CVD, multimorbidity, and frailty by inhibiting growth factors, increasing catabolism, and interfering with homeostatic signalling is supported by mechanistic studies but requires confirmation in humans. Whether early modulation of inflammageing prevents or delays the onset of cardiovascular frailty should be tested in clinical trials.

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Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty

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