Cardiovascular Aging: Perspectives from the Baltimore Longitudinal Study of Aging (BLSA)

The Baltimore Longitudinal Study of Aging (BLSA) was born in 1958, making it one of the oldest and longest studies of Aging in the United States. Lack of educational opportunities and socioeconomic disadvantage can have many negative effects on health, and the initial aim of the study was to separate these effects from the true effects of the aging processes. Thus, the primary focus was the scientific characterization of aging in individuals over their entire adult lifespan. With approximately 3,200 total volunteers over the life of the study, more than 1,400 men and women are current study participants, ranging in age from 20 to 94+ years. CV studies within the BLSA are conducted by the Laboratory of Cardiovascular Science (LCS) of the National Institute on Aging, Intramural Research Program in conjunction with other BLSA investigators. Primary foci in BLSA CV studies are on arterial stiffening and cardiac reserve. BLSA studies in humans and animals have explored the various facets of aging through this lens. In pursuit of these topics a number of corollary discoveries have been made, revealing a complex interplay between the heart and arterial system, aging, and CV diseases.The BLSA approach to defining and discussing aging begins with an attempt to separate aging and disease to the extent to which this is possible in the BLSA community dwelling, volunteer cohort. Initial characterization of age-associated changes in the CV (or any other organ) system utilizes a cross-sectional approach to describe changes over a broad age range. In some projects, cross-sectional measurements continue to be made to (i) provide greater statistical power to answer certain questions, (ii) address new hypotheses requiring simultaneous measurement of related new variables, (iii) incorporate rapid technological advances requiring de novo measurements, and (iv) monitor secular changes in important variables, mediated by lifestyle or environmental changes. Longitudinal measurements for many variables are made at pre-defined intervals to identify "true" aging changes, free from the selective survivorship effect of cross-sectional studies. Longitudinal studies make it possible to determine the rate of aging for specific variables. Another type of longitudinal study may monitor "outcomes" or "events" in relation to an initial measurement variable, such as myocardial infarction (MI) or cardiac death as predicted by prior exercise ECG and thallium scanning. BLSA studies frequently generate hypotheses that can only be tested by intervention studies. Short-term interventions such as physiological or pharmacological perturbations are typical of hypothesis-driven studies often used to define the mechanisms of age-related changes observed in cross-sectional or longitudinal investigations. This overview of BLSA CV research focuses on arterial aging and its effects on arterial-heart coupling.