Evolving Insights Regarding Biomarkers to Better Manage Older Adults With Cardiovascular Disease.

Abstract

Background: Aging is associated with subclinical changes in cardiac structure and function as well as an increase in prevalent cardiovascular disease and geriatric syndromes such as frailty and sarcopenia. This can result in levels of cardiac-specific and non-cardiac-specific circulating biomarkers that are frequently above normal range concentrations established in healthy middle-age general population cohorts in the absence of acute disease. Without this recognition, clinicians may be challenged to interpret biomarker results in older adults in the setting of diagnosing an acute illness or for longer term prognostication.

Content: In this review, we provide anticipated findings, their suggested underlying mechanism, as well as interpretation of concentrations for the common cardiovascular biomarkers including cardiac troponins and natriuretic peptides in the acute care and ambulatory settings. Specifically, information to interpret biomarkers in the setting of possible acute myocardial infarction and heart failure is presented. We also present data for interpreting results in older adults with other well-known prognostic biomarkers, as well as biomarkers with application to geriatric syndromes.

Summary: Circulating biomarkers, despite challenges in interpretation in older adults relative to younger adults, play a critical role in the diagnosis and prognosis of cardiovascular disease and have additional roles in geriatric syndromes and assessing risk of harm from specific treatments.