By Megan Rauscher
WESTPORT, CT (Reuters Health) – A high level of physical activity appears to preserve the cardioprotective effect of preinfarction angina in elderly patients, researchers report in the Journal of the American College of Cardiology for November 1st.
The reasons why advancing age is associated with increased mortality following acute MI are poorly understood, but evidence suggests that an age-related reduction in ischemic preconditioning is involved, lead researcher Dr. Pasquale Abete of the University of Naples told Reuters Health.
"Brief, repeated episodes of myocardial ischemia, so-called ischemic preconditioning, 'vaccinates' the heart against a more prolonged ischemic insult such as myocardial infarction," Dr. Abete said. The more typical clinical equivalent of ischemic preconditioning is preinfarction angina and adults with preinfarction angina have a better outcome than those without angina, the researcher noted.
Dr. Abete's group studied the effects of physical activity on preinfarction angina in 557 elderly patients with acute MI. In-hospital mortality was similar in elderly patients with and without preinfarction angina, 22.2% and 27.2%, respectively (p = 0.20).
A high level of physical activity was strongly associated with reduced in-hospital mortality in elderly patients with preinfarction angina but not those without preinfarction angina. This demonstrates that "the protective effect of preinfarction angina is preserved in elderly patients with a high level of physical activity," Dr. Abete said.
Editorialist Dr. Robert A. Kloner of the Good Samaritan Hospital in Los Angeles told Reuters Health that the main message here is that "staying in shape will help even the elderly heart."
"Previously, there had been this concern that an older heart might not be amenable to the concept of preconditioning," Dr. Kloner noted. "As the baby boomers begin to age and enter the age bracket in which CAD becomes common, it is good to know that there is hope even for the older heart. But it appears from this study that for ischemic preconditioning to work in the older heart, the person must be conditioned–that is, physically active."
J Am Coll Cardiol 2001;38:1357-1367.
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