NLRP3 inflammasome ‘off switch’ reverses effects of chronic inflammation – Research into age-related chronic inflammatory disorders has identified an ‘off switch’ on the NLRP3 inflammasome that could be targeted in new therapies #@ Aging-associated diseases @ Article: The relationship between aging and disease – Reviews in Clinical Gerontology – Volume 5, Issue 2May 1995 , pp. 125-141 – Published online by Cambridge University Press: 17 November 2008 @ Article: Trends of Cardiovascular Disease Mortality in Relation to Population Aging in Greece (1956 – 2015). @ Very Important Links and Images @ https://en.wikipedia.org/wiki/Mouse

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Pathol Res Pract. 2012 Jul 15;208(7):377-81. doi: 10.1016/j.prp.2012.04.006. Epub 2012 Jun 8.

The influence of physical activity in the progression of experimental lung cancer in mice

Renato Batista Paceli 1Rodrigo Nunes CalCarlos Henrique Ferreira dos SantosJosé Antonio CordeiroCassiano Merussi NeivaKazuo Kawano NagaminePatrícia Maluf Cury


Impact_Fator-wise_Top100Science_Journals

GRUPO_AF1GROUP AFA1 – Aerobic Physical Activity – Atividade Física Aeróbia – ´´My´´ Dissertation – Faculty of Medicine of Sao Jose do Rio Preto

GRUPO AFAN 1GROUP AFAN1 – Anaerobic Physical ActivityAtividade Física Anaeróbia – ´´My´´ Dissertation – Faculty of Medicine of Sao Jose do Rio Preto

GRUPO_AF2GROUP AFA2 – Aerobic Physical ActivityAtividade Física Aeróbia – ´´My´´ Dissertation – Faculty of Medicine of Sao Jose do Rio Preto

GRUPO AFAN 2GROUP AFAN 2 – Anaerobic Physical ActivityAtividade Física Anaeróbia´´My´´ Dissertation – Faculty of Medicine of Sao Jose do Rio Preto

Slides – mestrado´´My´´ Dissertation – Faculty of Medicine of Sao Jose do Rio Preto

CARCINÓGENO DMBA EM MODELOS EXPERIMENTAIS

DMBA CARCINOGEN IN EXPERIMENTAL MODELS

Avaliação da influência da atividade física aeróbia e anaeróbia na progressão do câncer de pulmão experimental – Summary – Resumo´´My´´ Dissertation Faculty of Medicine of Sao Jose do Rio Preto

https://pubmed.ncbi.nlm.nih.gov/22683274/

Abstract

Lung cancer is one of the most incident neoplasms in the world, representing the main cause of mortality for cancer. Many epidemiologic studies have suggested that physical activity may reduce the risk of lung cancer, other works evaluate the effectiveness of the use of the physical activity in the suppression, remission and reduction of the recurrence of tumors. The aim of this study was to evaluate the effects of aerobic and anaerobic physical activity in the development and the progression of lung cancer. Lung tumors were induced with a dose of 3mg of urethane/kg, in 67 male Balb – C type mice, divided in three groups: group 1_24 mice treated with urethane and without physical activity; group 2_25 mice with urethane and subjected to aerobic swimming free exercise; group 3_18 mice with urethane, subjected to anaerobic swimming exercise with gradual loading 5-20% of body weight. All the animals were sacrificed after 20 weeks, and lung lesions were analyzed. The median number of lesions (nodules and hyperplasia) was 3.0 for group 1, 2.0 for group 2 and 1.5-3 (p=0.052). When comparing only the presence or absence of lesion, there was a decrease in the number of lesions in group 3 as compared with group 1 (p=0.03) but not in relation to group 2. There were no metastases or other changes in other organs. The anaerobic physical activity, but not aerobic, diminishes the incidence of experimental lung tumors.

´´Mice are common experimental animals in laboratory research of biology and psychology fields primarily because they are mammals, and also because they share a high degree of homology with humans. They are the most commonly used mammalian model organism, more common than rats. The mouse genome has been sequenced, and virtually all mouse genes have human homologs. The mouse has approximately 2.7 billion base pairs and 20 pairs of chromosomes.[6] They can also be manipulated in ways that are illegal with humans, although animal rights activists often object. A knockout mouse is a genetically modified mouse that has had one or more of its genes made inoperable through a gene knockout. Reasons for common selection of mice are that they are small and inexpensive, have a widely varied diet, are easily maintained, and can reproduce quickly. Several generations of mice can be observed in a relatively short time. Mice and rats have the same organs in the same places, with the difference of size.´´

https://www.ncbi.nlm.nih.gov/pubmed/30159093

https://www.cambridge.org/core/journals/reviews-in-clinical-gerontology/article/relationship-between-aging-and-disease/84539F3E6C92122BA9A0766AB4971983

https://en.wikipedia.org/wiki/Aging-associated_diseases

NLRP3 inflammasome ‘off switch’ reverses effects of chronic inflammation

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NLRP3 inflammasome ‘off switch’ reverses effects of chronic inflammation

Research into age-related chronic inflammatory disorders has identified an ‘off switch’ on the NLRP3 inflammasome that could be targeted in new therapies.

mouse perched on researcher's gloved hands

Researchers have identified that deacetylation of a section of the NLRP3 inflammasome acts as an ‘off switch’ for inflammation. The team suggest that therapeutics targeting this switch could be used to improve or reverse a range of ageing-related disorders exacerbated by chronic inflammation, including multiple sclerosis (MS), Alzheimer’s, Parkinson’s, diabetes and cancers.

“My lab is very interested in understanding the reversibility of ageing,” said senior author Danica Chen, associate professor of metabolic biology, nutritional sciences and toxicology at University of California (UC), Berkeley, US. “In the past, we showed that aged stem cells can be rejuvenated. Now, we are asking: to what extent can ageing be reversed? And we are doing that by looking at physiological conditions, like inflammation and insulin resistance, that have been associated with ageing-related degeneration and diseases.”

The study showed that the overactivation of the NLRP3 inflammasome seen in chronic inflammation can be turned off by deacetylation of a certain residue.

Chen explained: “This acetylation can serve as a switch. So, when it is acetylated, this inflammasome is on. When it is deacetylated, the inflammasome is off.”

Direct link shown between inflammasome activation and Alzheimer’s…

In mice the team discovered that a protein, SIRT2, was responsible for deacetylating the NLRP3 inflammasome. When SIRT2 was knocked-out by the researchers, the mice had increased inflammation and higher insulin resistance by age two than their normal counterparts.

In older mice the team destroyed the immune system with radiation and then rebuilt it with stem cells, which either produced acetylated or deacetylated inflammasomes. Within six weeks the deacetylated NLRP3 inflammasome recipients had lowered insulin resistance; therefore, the researchers concluded that deacetylating the NLRP3 inflammasome could be a treatment for metabolic disease.

“I think this finding has very important implications in treating major human chronic diseases,” Chen said. “It’s also a timely question to ask, because in the past year, many promising Alzheimer’s disease trials ended in failure. One possible explanation is that treatment starts too late, and it has gone to the point of no return. So, I think it’s more urgent than ever to understand the reversibility of ageing-related conditions and use that knowledge to aid drug development for ageing-related diseases.”

The study was published in Cell Metabolism.

By Hannah Balfour (Drug Target Review)

6 February 2020

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Aging-associated diseases

From Wikipedia, the free encyclopediaJump to navigationJump to search

An aging-associated disease is a disease that is most often seen with increasing frequency with increasing senescence. Essentially, aging-associated diseases are complications arising from senescence. Age-associated diseases are to be distinguished from the aging process itself because all adult animals age, save for a few rare exceptions, but not all adult animals experience all age-associated diseases. Aging-associated diseases do not refer to age-specific diseases, such as the childhood diseases chicken pox and measles. “Aging-associated disease” is used here to mean “diseases of the elderly”. Nor should aging-associated diseases be confused with accelerated aging diseases, all of which are genetic disorders.

Examples of aging-associated diseases are atherosclerosis and cardiovascular diseasecancerarthritiscataractsosteoporosistype 2 diabeteshypertension and Alzheimer’s disease. The incidence of all of these diseases increases exponentially with age.[1]Age-Specific SEER Incidence Rates, 2003-2007

Of the roughly 150,000 people who die each day across the globe, about two thirds—100,000 per day—die of age-related causes.[2] In industrialized nations, the proportion is higher, reaching 90%.[2]

Contents

Patterns of differences[edit]

By age 3 about 30% of rats have had cancer, whereas by age 85 about 30% of humans have had cancer. Humans, dogs and rabbits get Alzheimer’s disease, but rodents do not. Elderly rodents typically die of cancer or kidney disease, but not of cardiovascular disease. In humans, the relative incidence of cancer increases exponentially with age for most cancers, but levels off or may even decline by age 60–75 [3](although colon/rectal cancer continues to increase).[4]

People with the so-called segmental progerias are vulnerable to different sets of diseases. Those with Werner’s syndrome suffer from osteoporosis, cataracts, and cardiovascular disease, but not neurodegeneration or Alzheimer’s disease; those with Down syndrome suffer type 2 diabetes and Alzheimer’s disease, but not high blood pressure, osteoporosis or cataracts. In Bloom syndrome, those afflicted most often die of cancer.

Research[edit]

Aging (senescence) increases vulnerability to age-associated diseases, whereas genetics determines vulnerability or resistance between species and individuals within species. Some age-related changes (like graying hair) are said to be unrelated to an increase in mortality. But some biogerontologists believe that the same underlying changes that cause graying hair also increase mortality in other organ systems and that understanding the incidence of age-associated disease will advance knowledge of the biology of senescence just as knowledge of childhood diseases advanced knowledge of human development.[5]

Strategies for Engineered Negligible Senescence (SENS) is a research strategy which aims to repair a few “root causes” for age-related illness and degeneration, as well as develop medical procedures to periodically repair all such damage in the human body, thereby maintaining a youth-like state indefinitely.[6] So far, the SENS programme has identified seven types of aging-related damage, and feasible solutions have been outlined for each. However, critics argue that the SENS agenda is optimistic at best, and that the aging process is too complex and little-understood for SENS to be scientific or implementable in the foreseeable future.[7][8][9]

Recently it has been proposed that age-related diseases are mediated by vicious cycles [10]

Diseases[edit]

Age-Related Macular Degeneration (AMD)[edit]

Age-Related Macular Degeneration (AMD) is a disease that affects the eyes and can lead to vision loss through break down of the central part of the retina called the macula. Degeneration can occur in one eye or both and can be classified as either wet (neovascular) or dry (atrophic). Wet AMD commonly is caused by blood vessels near the retina that lead to swelling of the macula.[11] The cause of dry AMD is less clear, but it is thought to be partly caused by breakdown of light-sensitive cells and tissue surrounding the macula. A major risk factor for AMD is age over the age of 60.[12]

Alzheimer’s disease[edit]

Alzheimer’s disease is classified as a “protein misfolding” disease. Aging causes mutations in protein folding, and as a result causes deposits of abnormal modified proteins accumulate in specific areas of the brain. In Alzheimer’s,deposits of Beta-amyloid and hyperphosphorylated tau protein form extracellular plaques and extracellular tangles.[13] These deposits are shown to be neurotoxic and cause cognitive impairment due to their initiation of destructive biochemical pathways.[14]

Atherosclerosis[edit]

Atherosclerosis is categorized as an aging disease and is brought about by vascular remodeling, the accumulation of plaque, and the loss of arterial elasticity. Over time, these processes can stiffen the vasculature. For these reasons, older age is listed as a major risk factor for atherosclerosis.[15] Specifically, the risk of atherosclerosis increases for men above 45 years of age and women above 55 years of age.[16]

Benign Prostatic Hyperplasia (BPH)[edit]

Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate gland due to increased growth.[17] An enlarged prostate can result in incomplete or complete blockage of the bladder and interferes with a man’s ability to urinate properly. Symptoms include overactive bladder, decreased stream of urine, hesitancy urinating, and incomplete emptying of the bladder.[18][19] By age 40, 10% of men will have signs of BPH and by age 60, this percentage increases by 5 fold. Men over the age of 80 have over a 90% chance of developing BPH and almost 80% of men will develop BPH in their lifetime.[17][20]

See also[edit]

References[edit]

  1. ^ Belikov, Aleksey V. (2019-01-01). “Age-related diseases as vicious cycles”. Ageing Research Reviews49: 11–26. doi:10.1016/j.arr.2018.11.002ISSN 1568-1637PMID 30458244.
  2. Jump up to:a b Aubrey D.N.J, de Grey (2007). “Life Span Extension Research and Public Debate: Societal Considerations” (PDF). Studies in Ethics, Law, and Technology1 (1, Article 5). CiteSeerX 10.1.1.395.745doi:10.2202/1941-6008.1011. Archived from the original (PDF) on October 13, 2016. Retrieved August 7, 2011.
  3. ^ Belikov, Aleksey V. (22 September 2017). “The number of key carcinogenic events can be predicted from cancer incidence”Scientific Reports7 (1): 12170. doi:10.1038/s41598-017-12448-7PMC 5610194PMID 28939880.
  4. ^ “SEER Cancer Statistics Review, 1975–2003” (PDF). Surveillance Epidemiology and End Results (SEER). National Cancer Institute. Archived from the original (PDF) on 2006-09-25. Retrieved 2006-11-20.
  5. ^ Hayflick, L (2004). “The not-so-close relationship between biological aging and age-associated pathologies in humans”. The Journals of Gerontology: Series A59 (6): B547–B550. doi:10.1093/gerona/59.6.B547PMID 15215261.
  6. ^ “The SENS Platform: An Engineering Approach to Curing Aging“. Methuselah Foundation. Retrieved on June 28, 2008.
  7. ^ Warner, H; Anderson, J; Austad, S; Bergamini, E; Bredesen, D; Butler, R; Carnes, BA; Clark, BF; et al. (2005). “Science fact and the SENS agenda”EMBO Reports6 (11): 1006–8. doi:10.1038/sj.embor.7400555PMC 1371037PMID 16264422.
  8. ^ De Grey, AD (2005). “Like it or not, life-extension research extends beyond biogerontology”EMBO Reports6 (11): 1000. doi:10.1038/sj.embor.7400565PMC 1371043PMID 16264420.
  9. ^ de Grey, Aubrey. “The biogerontology research community’s evolving view of SENS“. Methuselah Foundation. Retrieved on July 1, 2008.
  10. ^ Belikov, Aleksey V. (January 2019). “Age-related diseases as vicious cycles”. Ageing Research Reviews49: 11–26. doi:10.1016/j.arr.2018.11.002PMID 30458244.
  11. ^ Zarbin, Marco A. (2004-04-01). “Current Concepts in the Pathogenesis of Age-Related Macular Degeneration”Archives of Ophthalmology122 (4): 598–614. doi:10.1001/archopht.122.4.598ISSN 0003-9950.
  12. ^ “Facts About Age-Related Macular Degeneration | National Eye Institute”nei.nih.gov. Retrieved 2019-08-06.
  13. ^ Franceschi, Claudio; Garagnani, Paolo; Morsiani, Cristina; Conte, Maria; Santoro, Aurelia; Grignolio, Andrea; Monti, Daniela; Capri, Miriam; Salvioli, Stefano (2018-03-12). “The Continuum of Aging and Age-Related Diseases: Common Mechanisms but Different Rates”Frontiers in Medicine5doi:10.3389/fmed.2018.00061ISSN 2296-858XPMC 5890129PMID 29662881.
  14. ^ Bloom, George S. (2014-04-01). “Amyloid-β and Tau: The Trigger and Bullet in Alzheimer Disease Pathogenesis”JAMA Neurology71 (4): 505–508. doi:10.1001/jamaneurol.2013.5847ISSN 2168-6149.
  15. ^ Wang Julie C.; Bennett Martin (2012-07-06). “Aging and Atherosclerosis”Circulation Research111 (2): 245–259. doi:10.1161/CIRCRESAHA.111.261388.
  16. ^ “Atherosclerosis | National Heart, Lung, and Blood Institute (NHLBI)”http://www.nhlbi.nih.gov. Retrieved 2019-08-05.
  17. Jump up to:a b “Prostate Enlargement (Benign Prostatic Hyperplasia) | NIDDK”National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 2019-08-06.
  18. ^ “What is Benign Prostatic Hyperplasia (BPH)? – Urology Care Foundation”http://www.urologyhealth.org. Retrieved 2019-08-06.
  19. ^ “Benign Prostatic Hyperplasia (BPH) Guideline – American Urological Association”http://www.auanet.org. Retrieved 2019-08-06.
  20. ^ “Medical Student Curriculum: Benign Prostatic Hypertrophy (BPH) – American Urological Association”http://www.auanet.org. Retrieved 2019-08-06.

External links[edit]

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The relationship between aging and disease

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COPYRIGHT: © Cambridge University Press 1995

Corresponding author

Professor Michael A Horan, Department of Geriatric Medicine, Research and Teaching Building, Withington Hospital, Nell Lane, Manchester M20 8LR, UK.

References

 Hide All1Johnson, TE. Increased lifespan of age-1 mutants in Caenorhabditus elegans and lower Gompertz rate of aging. Science 1990; 249: 908–12.CrossRef | Google Scholar2Pearl, R. The biology of death, being a series of lectures delivered at the Lowell Institute in Boston in December 1920. Philadelphia: JB Lippincott, 1922.CrossRef | Google Scholar3Hayflick, L, Moorhead, PS. The serial cultivation of human diploid cell strain. Exp Cell Res 1961; 25: 585–61.CrossRef | Google Scholar4Goldstein, S. Aging in vitro: growth of cultured cells from the Galapagos tortoise. Exp Cell Res 1974; 83: 297–302.CrossRef | Google Scholar5Rohme, D. Evidence for a relationship between longevity of mammalian species and life span of normal fibroblasts in vitro and erythrocytes in vivoProc Nati Acad Sci USA 1981; 78: 5009–13.CrossRef | Google Scholar | PubMed6Martin, GM, Sprague, CA, Epstein, CJ. Replicative life span of cultivated human cells: effects of donor age, tissue and genotype. Lab Invest 1970; 23: 86–92.Google Scholar | PubMed7Schneider, EL, Mitsui, Y. The relationship between in vitro cellular aging and in vivo human age. Proc Natl Acad Sci USA 1976; 73: 3584–88.CrossRef | Google Scholar | PubMed8Goldstein, S, Moerman, EL, Soeloner, JS. Chronologic and physiologic age affect replicative life span of fibroblasts from diabetic, prediabetic and normal donors. Science 1978; 199: 781–82.CrossRef | Google Scholar | PubMed9Rittling, SR, Brooks, KM, Cristofalo, CJ, Baserga, R. Expression of cell cycle dependent genes in young and senescent WI-38 fibroblasts. Proc Natl Acad Sci USA 1986; 86: 3316–20.CrossRef | Google Scholar10Seshadri, T, Campisi, J. Repression of c-fos transcription and an altered genetic program in senescent human fibroblasts. Science 1990; 247: 205–209.CrossRef | Google Scholar | PubMed11Goletz, TA, Hensler, PJ, Yi, N, Adami, GR, Pereira-Smith, OM. Evidence for a genetic basis for the model system of cellular senescence, J Am Geriatr Soc 1993; 41: 1255–58.Google Scholar | PubMed12Bayreuther, K, Francz, PI, Gogol, J, Hapke, C, Maier, M, Meinrath, HG. Differentiation of primary and secondary fibroblasts in cell culture systems. Mutat Res 1991; 256: 233–42.CrossRef | Google Scholar | PubMed13Krohn, PL. Heterochronic transplantation in the study of ageing. Proc R Soc Lond 1962; B157: 128–47.CrossRef | Google Scholar14Harrison, DE. Normal function of transplanted marrow cell lines from aged mice. J Gerontol 1975; 30: 279–85.CrossRef | Google Scholar | PubMed15Cutler, RG. Evolutionary biology of aging and longevity in mammalian species. In: Johnson, JE ed. Aging and cell function. New York: Plenum Press, 1984: 1–147.Google Scholar16Korthas, JK. Neuropathies. In: Barclay, L ed. Clinical geriatric neurology. Philadelphia: Lea and Febiger, 1993: 283–93.Google Scholar17Brody, H. The effects of age upon the main nucleus of the inferior olive in the human. J Comp Neurol 1975;155: 61–71.Google Scholar18Vijayashankar, N, Brody, H. A quantitative study of the pigmented neurons in the nuclei locus coeruleus and subcoeruleus in man as related to aging. J Neuropathol 1979; 38: 490–97.CrossRef | Google Scholar19Duara, R, London, ED, Rapoport, SI. Changes in structure and energy metabolism of the aging brain. In: Finch, CE, Schneider, EL eds. Handbook of the biology of aging, second edition. New York: Van Nostrand Reinhold, 1985: 595–616.Google Scholar20Colman, CW, Holets, VR. Structural changes at synapses with age: plasticity and regeneration. In: Finch, CE, Schneider, EL eds. Handbook of the biology of aging, second edition. New York: Van Nostrand Reinhold, 1985: 617–44.Google Scholar21Carroff, SN. The neuroleptic malignant syndrome. J Clin Psychiatry 1980; 41: 79–83.Google Scholar22Orgel, LE. The maintenance of the accuracy of protein synthesis and its relevance to ageing. Proc Natl Acad Sci USA 1963; 49: 517–21.CrossRef | Google Scholar | PubMed23Rothstein, M. Evidence for and against the error catastrophe hypothesis. In: Warner, HR, Butler, RN, Sprott, RL, Schneider, EL eds. Modern biological theories of aging. New York: Raven Press, 1987: 139–54.Google Scholar24Orgel, LE. The maintenance of the accuracy of protein synthesis and its relevance to ageing: a correction. Proc Natl Acad Sci USA 1970; 67: 1476–80.CrossRef | Google Scholar | PubMed25Ono, T, Cutler, RG. Age-dependent relaxation of gene repression: increase of endogenous murine leukaemia virus-related and globin-related RNA in brain and liver of mice. Proc Natl Acad Sci USA 1978; 75: 4431–36.CrossRef | Google Scholar26Wallace, DC. Mitochondrial genetics: a paradigm for aging and degenerative diseases? Science 1992; 256: 628–32.CrossRef | Google Scholar | PubMed27Lee, CM, Chung, SS, Kaczkowski, JM, Weindruch, R, Aitken, JM. Multiple mitochondrial DNA deletions associated with age in skeletal muscle of rhesus monkeys. J Gerontol 1993; 48: B201–B205.CrossRef | Google Scholar | PubMed28Beal, MF. Does impairment of energy metabolism result in excitotoxic neuronal death in neurodegenerative illnesses? Ann Neural 1992; 31: 119–30.CrossRef | Google Scholar | PubMed29Linnane, AW, Marzuki, S, Ozawa, T, Tanaka, M. Mitochondrial DNA mutations as an important contribution to aging and degenerative diseases. Lancet 1989; i: 642–45.CrossRef | Google Scholar30Kohn, RR. Principles of mammalian aging. New Jersey: Prentice Hall, 1971: 20.Google Scholar31Hay, ED ed. Cell biology of the extracellular matrix. New York: Plenum, 1991.CrossRef | Google Scholar32Bjorksten, J. Crosslinkage and the aging process. In: Rothstein, M ed. Theoretical aspects of aging. New York: Academic Press, 1974: 43–59.CrossRef | Google Scholar33Robert, L, Labat-Robert, J. Cell-matrix interactions, their importance in ageing at the tissue level. Eur J Gerontol 1991; 2: 82–91.Google Scholar34Labat-Robert, J, Robert, L. Aging of the extracellular matrix and its pathology. Exp Gerontol 1988; 23: 5–18.CrossRef | Google Scholar | PubMed35Zharhary, D, Klinman, NR. Antigen responsiveness of the mature and generative B cell population of aged mice. J Exp Med 1983; 157: 1300–308.CrossRef | Google Scholar36Zharhary, D. T cell involvement in the decrease of antigen-responsive B cells in aged mice. Eur J Immunol 1986; 16: 1175–78.CrossRef | Google Scholar | PubMed37Blaivas, M, Carlson, BM. Muscle fiber branching – difference between grafts in old and young rats. Mech Ageing Dev 1991; 60: 43–53.CrossRef | Google Scholar | PubMed38Gutmann, E, Carlsson, BM. Regeneration and transplantation of muscle in old rats and between young and old rats. Life Sci 1976; 18: 109–14.CrossRef | Google Scholar39Zacks, SI, Sheff, MF. Age-related impeded regeneration of mouse minced anterior tibial muscle. Muscle Nerve 1982; 5: 152–61.CrossRef | Google Scholar | PubMed40Sadeh, M. Effects of aging on skeletal muscle regeneration. J Neural Sci 1988; 87: 67–74.CrossRef | Google Scholar | PubMed41Davis, KM, Fish, LC, Elahi, D, Clark, BA, Minaker, KL. Atrial natriuretic peptide levels in the prediction of congestive heart failure risk in frail elderly. J Am Med Assoc 1992; 267: 2625–29.CrossRef | Google Scholar | PubMed42Gerstenblith, G. Echocardiographic assessment of a normal adult aging population. Circulation 1977; 56: 273–78.CrossRef | Google Scholar | PubMed43Rodeheffer, RJ, Gerstenblith, G, Becker, LC. Exercise cardiac output is maintained with advancing age in healthy human subjects. Circulation 1984; 69: 203–13.CrossRef | Google Scholar | PubMed44Lakatta, EG. Cardiovascular regulatory mechanisms in advanced age. Physiol Rev 1993; 73: 413–67.CrossRef | Google Scholar | PubMed45Shannon, RP, Wei, JY, Rosa, PM. The effect of age and sodium depletion on cardiovascular response to orthostasis. Hypertension 1986; 8: 438–43.CrossRef | Google Scholar | PubMed46Cross, JS, Neufeld, RR, Libow, LS. Autopsy study of the elderly institutionalised patient. Arch Intern Med 1988; 148: 173–76.Google Scholar47Hadley, EC. Causes of death amongst the oldest old. In: Suzman, RM, Willis, DP, Manton, KG eds. The oldest old. Oxford: Oxford University Press, 1992: 183–96.Google Scholar48Macfadyen, D. International demographic trends. In: Kane, RL, Evans, JG, Macfadyen, D eds. Improving the health of older people: a world view. Oxford: Oxford University Press, 1990: 19–29.Google Scholar49Rose, G, Marmot, MG. Social class and coronary heart disease. Br Heart J 1981; 45: 13–19.CrossRef | Google Scholar | PubMed50Barker, DJP. Fetal and infant origins of adult disease. London: British Medical Journal, 1992.Google Scholar51Lass, JL. Herpes zoster: protecting older patients’ vision. Geriatrics 1984; 39: 79–80; 85–87; 91–94.Google Scholar | PubMed52Berger, R, Florent, G, Just, M. Decrease of the lymphoproliferative response to varicella-zoster virus antigen in the aged. Infect Immun 1981; 32: 24–27.Google Scholar | PubMed53Dutt, AK, Stead, WW. Tuberculosis. In: Yoshikawa, TT ed. Clinics in geriatric medicine. 1992; 8(4): 761–775.Google Scholar54Rich, AR. The pathogenesis of tuberculosis, second edition. Springfield, IL: Charles C Thomas, 1951: 110.Google Scholar55Dubrow, EL. Reactivation of tuberculosis: a problem of aging. J Am Geriatr Soc 1976; 24: 481–84.CrossRef | Google Scholar | PubMed56Geboes, K, Bossaert, H. Reactivation of tuberculosis in old age. J Am Geriatr Soc 1977; 25: 318–23.CrossRef | Google Scholar | PubMed57Reichman, LB, O’Day, R. Tuberculosis infection in a large urban population. Am Rev Respir Dis 1978; 117: 705–709.Google Scholar58Imre, S, Juhasz, E. The effect of oxidative stress on inbred mice of different ages. Mech Ageing Dev 1987;38: 259–66.CrossRef | Google Scholar | PubMed59Baird, MB, Sanir, HV. Regulation of catalase activity in mice of different ages. Gerontologia 1971; 17: 105–15.CrossRef | Google Scholar | PubMed60Reiss, U, Gershon, D. Comparison of cytoplasmic Superoxide dismutase in liver, heart, and brain of aging rats and mice. Biochem Biophys Res Commun 1976; 73: 255–62.CrossRef | Google Scholar | PubMed61Stohs, SJ, Hassing, JM, Al-Turk, WA, Masoud, AN. Glutathione levels in hepatic and extrahepatic tissues of mice as a function of age. Age 1980; 3: 11–14.CrossRef | Google Scholar62Hazelton, GA, Lang, CA. Glutathione contents of tissues in the aging mouse. Biochem J 1980; 188: 25–30.CrossRef | Google Scholar | PubMed63Stohs, SJ, El-Rashidy, FH, Lawson, T, Kobayashi, RH, Wulf, BG, Potter, JF. Changes in glutathione and glutathione metabolising enzymes in human erythrocytes and lymphocytes as a function of age. Age 1984; 7: 3–7.CrossRef | Google Scholar64Hart, JG, Timbrell, JA. The effect of age on paracetamol hepatotoxicity in mice. Biochem Pharmacol 1979; 28: 3015–17.CrossRef | Google Scholar | PubMed65Beiersdchmitt, WP, Keenan, KP, Weiner, M. Age-related increased susceptibility of male Fisher 344 rats to acetaminophen nephrotoxicity. Life Sci 1986; 39: 2335–42.CrossRef | Google Scholar66Kennah, HE, Coetzee, ML, Ove, P. A comparison of DNA repair synthesis in primary hepatocytes from old and young rats. Mech Ageing Dev 1985; 29: 283–98.CrossRef | Google Scholar67Von Hoff, DD, Layard, MW, Basa, P et al. Risk factors for doxorubicin-induced congestive heart failure. Ann Intern Med 1979; 91: 710–17.CrossRef | Google Scholar | PubMed68McMartin, DN, Engel, SG. Effect of aging on gentamicin nephrotoxicity and pharmacokinetics in rats. Res Commun Chem Pathol Pharmacol 1982; 38: 193–207.Google Scholar | PubMed69Goldstein, RS, Pasino, DA, Hook, JB. Cephaloridine nephrotoxicity in aging male Fisher 344 rats. Toxicology 1986; 38: 43–56.CrossRef | Google Scholar70Storer, JB. Radiation resistance with age in normal and irradiated populations of mice. Radiation Res 1965; 25: 435–59.CrossRef | Google Scholar71Finch, SC. The study of atomic bomb survivors in Japan. Am J Med 1979; 66: 899–901.CrossRef | Google Scholar72Miura, K, Goldstein, RS, Morgan, DG, Pasino, DA, Hewitt, WR, Hook, JB. Age-related differences in suceptibility to renal ischaemia in rats. Toxicol Appl Pharmacol 1987; 87: 284–96.CrossRef | Google Scholar73National Cancer Institute. Division of cancer treatment and control. Surveillance, epidemiology and end results program. NIH publication no. 90–2289. Bethesda, MD: National Cancer Institute.Google Scholar74Armitage, P, Doll, R. A two-stage theory of carcinogenesis in relation to the age distribution of human cancer. Br J Cancer 1957; 11: 161–69.CrossRef | Google Scholar | PubMed75Farber, E. The multistep nature of cancer development. Cancer Res 1984; 44: 4217–23.Google Scholar | PubMed76Ebbesen, P. Cancer and normal aging. Mech Ageing Dev 1984; 25: 269–83.CrossRef | Google Scholar77Vijg, J, Mullaart, E, Lohman, PHM, Knook, DL. UV-induced unscheduled DNA synthesis in fibroblasts of aging inbred rats. Mutation Res 1985; 146: 197–204.CrossRef | Google Scholar | PubMed78Vijg, J, Mullaart, E, Roza, L. Immunochemical detection of DNA in alkaline sucrose gradient fractions. J Immunol Methods 1986; 91: 53–58.CrossRef | Google Scholar | PubMed79Yu, LP, Smith, GN, Brandt, KD, Myers, SL, O’Connor, BL, Brandt, DA. Reduction of the severity of canine osteoarthritis by prophylactic treatment with oral doxycycline. Arthritis Rheum 1992;35: 1150–59.CrossRef | Google Scholar | PubMed80Harley, CB, Futcher, AB, Greider, CW. Telomeres shorten during aging of human fibroblasts. Nature 1990; 345: 458–60.CrossRef | Google Scholar | PubMed81Harley, CB. Telomere loss: mitotic clock or genetic time bomb? Mutation Res 1991; 256: 1271–82.Google Scholar | PubMed82Greenber, RS, Shuster, JL. Epidemiology of cancer in children. Epidemial Rev 1985; 7: 22–48.CrossRef | Google Scholar83MacMahon, B. Epidemiology of Hodgkin’s disease. Cancer Res 1966; 26: 1189–1201.Google Scholar | PubMed84Correa, P, O’Connor, GT. Epidemiologic patterns of Hodgkin’s disease. Int J Cancer 1971; 8: 192–201.CrossRef | Google Scholar | PubMed85Abramson, JH. Childhood experience and Hodgkin’s disease in adults. An interpretation of incidence data. Isr J Med Sci 1974; 16: 1365–70.Google Scholar86Vogelstein, B, Pearson, ER, Hamilton, SR. Genetic alterations during colorectal tumour development. N Engl J Med 1988; 319: 525–32.CrossRef | Google Scholar87Fearon, ER, Vogelstein, B. A genetic model for colorectal tumorigenesis. Cell 1990; 61: 759–67.CrossRef | Google Scholar | PubMed88Yancik, R. Ovarian cancer: age contrasts in incidence, histology, disease stage at diagnosis, and mortality. Cancer 1993; 71 (suppl): 517–23.CrossRef | Google Scholar89Ershler, WB. Geriatric correlates of experimental tumour biology. Oncology 1993; 6 (suppl): 58–61.Google Scholar90Kaesberg, PR, Ershler, WB. The change in tumour aggressiveness with age: lessons from experimental animals. Semin Oncol 1989; 16: 29–33.Google Scholar | PubMed91Ershler, WB, Stewart, JA, Hacker, MP, Moore, AL, Tindle, BH. B16 murine melanoma and aging: slower growth and longer survival in old mice. J Natl Cancer Inst 1984; 72: 161–63.CrossRef | Google Scholar | PubMed92Yuhas, JM, Pazimo, NH, Procter, JO. A direct relationship between immune competence and the subcutaneous growth rate of a malignant murine lung tumour. Cancer Res 1974; 34: 722–28.Google Scholar93Hirayama, R, Takemura, K, Nihei, Z et al. Differential effect of host microenvironment and systemic humoral factors on the implantation and the growth rate of metastatic tumor in parabiotic mice constructed between young and old mice. Mech Ageing Dev 1993; 71: 213–21.CrossRef | Google Scholar94Ershler, WE, Gamelli, RL, Moore, AL. Experimental tumours and aging: local factors that may account for the observed age advantage in the B16 melanoma model. Exp Gerontol 1984; 19: 367–76.CrossRef | Google Scholar95Ershler, WB, Socinski, MA, Greene, CJ. Bronchogenic cancer, metastasis and aging. J Am Geriatr Soc 1983; 31: 673–76.CrossRef | Google Scholar | PubMed96Hadar, E, Ershler, WB, Kreisle, RA. Lymphocyte-induced angiogenesis factor is produced by L3T4+ murine T lymphocytes, and its production declines with age. Cancer Immunol Immunother 1988; 26: 31–34.CrossRef | Google Scholar | PubMed97Ershler, WB. The influence of an aging immune system on cancer incidence and progression. J Gerontol 1993; 48: B3–B7.CrossRef | Google Scholar | PubMed98Kim, YT, Scwab, R, Siskind, GW, Weksler, ME. Cellular basis for the slower growth of the B16 melanoma in old mice. Aging Immunol Infect Dis 1989; 1: 237–44.Google Scholar99Kreisle, R, Stebler, BA, Ershler, WB. Effect of host age on tumour-associated angiogenesis in mice. J Natl Cancer Inst 1990; 82: 44–47.CrossRef | Google Scholar100McGandy, RB, Barows, CH, Spanias, CH, Meredith, A, Stone, JL, Norris, AH. Nutrient intake and energy expenditure in men of different ages. J Gerontol 1966; 21: 581–84.CrossRef | Google Scholar101Munro, HN, Suter, NM, Russel, RM. Nutritional requirements of the elderly. Anna Rev Nutr 1987; 7: 23–49.CrossRef | Google Scholar | PubMed102Forbes, GB, Reina, JB. Adult lean body mass declines with age: some longitudinal observations. Metabolism 1970; 19: 653–63.CrossRef | Google Scholar | PubMed103Martineau, L, Horan, MA. Pharmacological and nutritional approaches to muscle wasting in the aged. Pharmacol Ther 1995 (in press).Google Scholar104Shephard, RJ. Physical activity and aging, second edition. London: Croom Helm, 1987.Google Scholar105Gersovitz, M, Motil, K, Munro, HN, Scrimshaw, NS, Young, VR. Human protein requirements: assessment of the adequacy of the current recommended dietary allowance for dietary protein in elderly men and women. Am J Clin Nutr 1982; 35: 6–14.CrossRef | Google Scholar | PubMed106Sullivan, DH, Moriarty, MS, Chernoff, R, Lipschitz, DA. An analysis of the quality of care routinely provided to elderly hospitalized veterans. JPENJ Parenter Enteral Nutr 1987; 13: 249–54.CrossRef | Google Scholar107Bastow, MD, Rawlings, J, Allison, SP. Under-nutrition, hypothermia, and injury in elderly women with fractured femur: an injury response to altered metabolism? Lancet 1983; i: 143–46.CrossRef | Google Scholar108Patterson, BM, Cornell, CN, Carbone, B, Levine, B, Chapman, D. Protein depletion and metabolic stress in elderly patients who have a fracture of the hip. J Bone Joint Surg USA 1992; 74–A: 251–60.CrossRef | Google Scholar | PubMed109Sullivan, DH, Patch, GA, Walls, RC, Lipschitz, DA. Impact of nutrition status on morbidity and mortality in a select population of geriatric rehabilitation patients. Am J Clin Nutr 1990; 51: 749–58.CrossRef | Google Scholar110Rich, MW, Bosner, MS, Chung, MK, McKenzie, JP. Is age an independent predictor of early and late mortality in patients with acute myocardial infarction? Am J Med 1992; 92: 7–13.CrossRef | Google Scholar | PubMed111Benfante, R, Reed, D, Frank, J. Do coronary heart disease risk factors measured in the elderly have the same predictive roles as in the middle-aged: comparisons of relative and attributable risks. Ann Epidemiol 1992; 2: 273–82.CrossRef | Google Scholar | PubMed112Harris, TB, Makuc, DM, Kleinman, JC et al. Is the serum cholesterol – coronary heart disease relationship modified by activity level in older persons? J Am Geriatr Soc 1991; 39: 447–54.CrossRef | Google Scholar | PubMed113Sorkin, JD, Andres, R, Muller, DC, Baldwin, HL, Fleg, JL. Cholesterol as a risk factor for coronary heart disease in elderly men: the Baltimore longitudinal study on aging. Ann Epidemiol 1992; 2: 59–67.CrossRef | Google Scholar | PubMed114Wong, ND, Wilson, PWF, Kannel, WB. Serum cholesterol as a prognostic factor after myocardial infarction: the Framingham study. Ann Intern Med 1991; 115: 687–93.CrossRef | Google Scholar | PubMed115Horan, MA, Hendriks, HFJ, Brouwer, A. Systems under stress: infectious agents and host defences. In: Horan, MA, Brouwer, A eds. Gerontology: approaches to biomedical and clinical research. London: Edward Arnold, 1990: 105–34.Google Scholar116Lord, SR, Clark, RD, Webster, IW. Physiological factors associated with falls in an elderly population. J Am Geriatr Soc 1991; 39: 1194–1200.CrossRef | Google Scholar117Gibson, MJ. Falls in later life. In: Kane, RL, Evans, JG, Macfadyen, D eds. Improving the health of older people: a world view. Oxford: Oxford University Press, 1990: 290–315.Google Scholar118Isaacs, B. Current achievements in geriatrics; morbidity in elderly hospital patients. London: Cassell, 1964.Google Scholar119Cape, RDT. A geriatric service. Midlands Med Rev 1972; 8: 21–30.Google Scholar120Williamson, J, Stokoe, IH, Gray, S et al. Old people at home. Their unreported needs. Lancet 1967; i: 1117–20.Google Scholar121Ebrahim, S, Hedley, R, Sheldon, M. Low levels of ill health among elderly non-consulters in general practice. BMJ 1984; 289: 1273–75.CrossRef | Google Scholar | PubMed122Williams, ES, Barley, NH. Old people not known to the general practitioners: low risk group BMJ 1985; 291: 251–54.CrossRef | Google Scholar123Blazer, D, George, L, Landerman, R. The phenomenology of late life depression. In: Bebington, PE, Jacoby, R eds. Psychiatric disorders of the elderly. London: Mental Health Foundation, 1986; 143–52.Google Scholar124Rodstein, M. The characteristics of non-fatal myocardial infarction in the aged. Arch Intern Med 1956; 98: 84–90.CrossRef | Google Scholar125Pathy, MS. Clinical presentation of myocardial infarction in the elderly. Br Heart J 1967; 29: 190–99.CrossRef | Google Scholar | PubMed126Burston, GR, Moore-Smith, B. Occult surgical emergencies in the elderly. Br J Clin Pract 1979; 24: 239–43.Google Scholar127Clinch, D, Banerjee, AK, Ostick, G. Absence of abdominal pain in elderly patients with peptic ulcer. Age Ageing 1984; 13: 120–23.CrossRef | Google Scholar | PubMed128Fulton, JD, Peebles, SE, Smith, GD, Davies, JW. Unrecognised viscus perforation in the elderly. Age Ageing 1989; 18: 403–406.CrossRef | Google Scholar129Madden, JW, Croker, JR, Beynon, GPJ. Septicaemia in the elderly. Postgrad Med J 1987; 57: 502–506.CrossRef | Google Scholar130Droste, K, Roskamm, H. Silent myocardial ischaemia. Am Heart J 1989; 118: 1087–92.CrossRef | Google Scholar131Gjorup, T, Hendriksen, T, Lund, E, Stromgard, E. Is growing old a disease? A study of the attitudes of elderly people to physical symptoms. J Chron Dis 1987;40: 1095–97.CrossRef | Google Scholar132Krumholz, HM, Pasternak, RC, Weinstein, MC et al. Cost-effectiveness of thrombolytic therapy with streptokinase in elderly patients with suspected acute myocardial infarction. N Engl J Med 1992; 327: 7–13.CrossRef | Google Scholar | PubMed133Grover, SA, Cook, EF, Adam, J, Coupal, L, Goldman, L. Delayed diagnosis of gynaecologic tumours in elderly women: relation to national medical practice patterns. Am J Med 1989; 86: 151–57.CrossRef | Google Scholar134Binstock, RH, Post, SG eds. Too old for health care? Baltimore: Johns Hopkins University Press, 1991.Google Scholar

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Open Cardiovasc Med J. 2018 Jul 31;12:71-79. doi: 10.2174/1874192401812010071. eCollection 2018.

Trends of Cardiovascular Disease Mortality in Relation to Population Aging in Greece (1956 – 2015).

Kollia N1Tragaki A2Syngelakis AI3Panagiotakos D1,4,5,6.

Author information

Abstract

BACKGROUND:

Demographic dynamics and decreasing trends in mortality from chronic diseases are major contributors to the phenomenon of population aging. The purpose of the present study was to examine the association between cardiovascular disease (CVD) mortality and demographic indicators, in Greece the past 60 years.

METHODS:

Life Expectancy at birth (LE), population age structure, fertility rates (TFR) and all-cause, CVD mortality rates were retrieved (data provided by the Hellenic Statistical Authority, 1956-2015). In order to test the research hypothesis time-series analysis was conducted.

RESULTS:

Increasing trends in LE and in the older age (>65 or >80 years) groups’ share and declining trends in TFR were recorded. CVD mortality, after an upward course, showed decreasing trends during 1988-2009, accounting for the 96% and 97% increment in LE in men and women respectively. However, newer records (2010-2015) show a new upward trend. The declining trends in TFR were highly associated with the shifts towards the upper part of the population age pyramid.

CONCLUSION:

Population aging is a historically unprecedented event that cannot be avoided, deterred or alleviated. Its negative effects act cumulatively with the recent increases in cardiovascular mortality, especially in the light of the ongoing economic crisis which is expected to further exacerbate the existing contrasts. A possible way to successfully cope with the new demographic realities is to unlock an, up till now largely overlooked, opportunity named “healthy aging”.

KEYWORDS:

Cardiovascular disease; Demographic changes; Fertility; Life expectancy; Mortality; Population agingPMID: 30159093 PMCID: PMC6080059 DOI: 10.2174/1874192401812010071Free PMC Article

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Open Cardiovasc Med J. 2018; 12: 71–79.Published online 2018 Jul 31. doi: 10.2174/1874192401812010071PMCID: PMC6080059PMID: 30159093

Trends of Cardiovascular Disease Mortality in Relation to Population Aging in Greece (1956 – 2015)

Natasa Kollia,1Alexandra Tragaki,2Aristomenis I. Syngelakis,3 and Demosthenes Panagiotakos1,4,5,6,*Author informationArticle notesCopyright and License informationDisclaimerThis article has been cited by other articles in PMC.Go to:

Abstract

Background:

Demographic dynamics and decreasing trends in mortality from chronic diseases are major contributors to the phenomenon of population aging. The purpose of the present study was to examine the association between cardiovascular disease (CVD) mortality and demographic indicators, in Greece the past 60 years.

Methods:

Life Expectancy at birth (LE), population age structure, fertility rates (TFR) and all-cause, CVD mortality rates were retrieved (data provided by the Hellenic Statistical Authority, 1956-2015). In order to test the research hypothesis time-series analysis was conducted.

Results:

Increasing trends in LE and in the older age (>65 or >80 years) groups’ share and declining trends in TFR were recorded. CVD mortality, after an upward course, showed decreasing trends during 1988–2009, accounting for the 96% and 97% increment in LE in men and women respectively. However, newer records (2010-2015) show a new upward trend. The declining trends in TFR were highly associated with the shifts towards the upper part of the population age pyramid.

Conclusion:

Population aging is a historically unprecedented event that cannot be avoided, deterred or alleviated. Its negative effects act cumulatively with the recent increases in cardiovascular mortality, especially in the light of the ongoing economic crisis which is expected to further exacerbate the existing contrasts. A possible way to successfully cope with the new demographic realities is to unlock an, up till now largely overlooked, opportunity named “healthy aging”.Keywords: Population aging, Cardiovascular disease, Mortality, Life expectancy, Fertility, Demographic changesGo to:

1. INTRODUCTION

Recent trends in cardiovascular disease (CVD) mortality show remarkable declining rates in European countries and North America [1]. Despite this evidence, CVD is still the number one cause of death in most OECD (Organisation for Economic Co-operation and Development) countries, accounting for more than one-third of all deaths in 2015 [2]. Furthermore, the prevalence of common CVD risk factors like hypertension, obesity, hypercholesterolemia and diabetes have increased [34], especially in younger people [1], implying that cardiometabolic co-morbidity does not necessarily follow mortality trends. Furthermore, since cardiovascular health seems to be highly associated with socioeconomic factors5 and the reduction in CVD mortality over the past years has not been felt equally in all sectors of society – the most impressive improvements in cardiovascular health benefited the richest societal groups and countries [5] – the investigation of the most current CVD mortality trends (i.e. under the context of the ongoing economic crisis) is of particular value.

Alongside, during the last decades, substantial demographic changes have been recorded. Globally, life expectancy at birth has increased by approximately 25 years since the 1950s [6], probably due to the declining mortality rates attributed mainly to the spectacular improvements in health care, in pharmacological and other treatment and in general to the advances in medical science. The increment in life expectancy, while undeniably a major achievement, coupled with falling fertility rates, reshapes population pyramids and shifts volumes towards older age groups, a phenomenon widely known as population aging. Europe is by all means the oldest region of the planet. Currently, half of the European population is over 42 years of age, while 1 out of 4 Europeans is above 60 years of age [7].

Of all areas, health care is particularly sensitive to a population’s age-structure. Increasing shares of elder and old age groups are expected to affect: (i) the demand, (ii) the organization and delivery, and, (iii) the cost of health care systems. In parallel, in the context of the economic crisis, the increased cost of health care for the elderly creates the risk of raising ethical issues concerning rationing in Medicine (the allocation of scarce resources) [8]. Moreover, as longevity allows greater number of persons to reach higher ages, previously uncommon conditions become frequent, if not dominant morbidity causes. Particularly, CVD risk levels increase with age since the key risk factors are either directly age-related – like hypertension, diabetes, elevated cholesterol levels – or have a cumulative harmful effect, like tobacco use, obesity and physical inactivity [9]. Against this challenging demographic background and taking into account that age is one of the most dominant determinants of cardiovascular health, CVDs are expected to remain the leading cause of death in the years to come.

In the context of the aforementioned considerations, this paper aims to examine the effect of the trends in CVD mortality on longevity and on population age structure in Greece, during 1956 – 2015 and to discuss the implications and challenges arising from this favorable, but, also complex phenomenon involving the modern western world.Go to:

2. METHODS

2.1. Official Statistics

Demographic indicators, such as life expectancy at birth (LE), fertility rates (TFR), population age structure (1960-2015) and all-cause, CVD mortality rates (1956-2015) have been calculated using data provided by the Hellenic Statistical Authority (EL.STAT.) [10] and the EUROSTAT (Directorate-General of the European Commission) Population Projections-Baseline scenario [1013].

2.2. Statistical Analysis

Mortality rates were presented per 100,000 persons. Time trends in the demographic indices and in mortality rates were graphically presented (Figs. ​11 and ​22 respectively). Time-series analysis was conducted to evaluate the effect of all-cause and CVD mortality and fertility trends during 1956-2015 (independent determinants) on life expectancy and on the age structure of the Greek population (outcomes), in men and women separately. Due to the presence of a significant interaction between time and the independent variables, a stratified by year analysis was implemented. The estimated b-coefficients along with the 95% confidence intervals, the corresponding p-values and the adjusted R2 were provided. All reported p-values were based on two-sided tests and overall statistical significance level was set at 5%. STATA software, version 14 (MP & Associates, Sparta, Greece) was used for all statistical analyses.

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Demographic time trends in Greece (1956–2015); source: Hellenic Statistics Authority [10].

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Mortality time trends in Greece (1956–2015); source: Hellenic Statistics Authority. CVD: cardiovascular disease; CHD: coronary heart disease. Mortality rates were calculated per 100,000 persons [10].Go to:

3. RESULTS

3.1. Population Aging in Greece

According to the latest official statistics (population estimates 2015), the median age of the Greek population has increased by approximately 10 years since 1970s (i.e. from 32.3 to 43.4 years), and it is expected to further increase in the future (Table ​11). According to the projections provided by EUROSTAT (baseline scenario) [11] by 2030, half of the Greek population will be over 50 years age; more than one-third will be above 65 years and almost 9% will be above 80 years, in contrast to the youngest population segment which will be limited to just 11% (Table ​11). In particular, the group aged 0-14 comprise a rapidly shrinking part of the Greek population; already <20% in the 1990s, their share dropped down to as low as 14.5% in 2015. At the other end of the age spectrum, those above 65 years old currently represent 27% of total population, which is 31% higher than in 2000. The growth rate of those above 80 years old is even more spectacular, as their share more than doubled since the 1990s (Table ​11). The time trends of the Greek population age structure during the last 60 years are presented in Fig. (​11).

Table 1

Population age distribution for the Greek population, during the years 1970–2030.

Year197019801990200020152030a
Total Population, N8,300,3998,780,5149,584,18410,120,89210,775,6279,944,658
<15 years old (%)24.223.119.514.714.511.7
65 – 80 years old (%)11.113.113.717.320.927.2
>80 years old (%)2.02.33.03.56.38.7
Median age (years)323436384350

a EUROSTAT Population Projections according to baseline scenario [11].

3.2. Life Expectancy and fertility Trends

The time trends of life expectancy at birth are similar for both men and women and exhibit a linearly increasing course with men having consistently, approximately 3 years shorter estimates (Fig. ​11). In 2015, life expectancy was increased by 13 years for women and by 11 years for men compared with 1960 with an increasing rate of 0.20 [95% confidence intervals (CIs): 0.20-0.21), p<0.001] and 0.17 (95% CIs: 0.16-0.17, p<0.001) per year, respectively. Using the National Vital Statistics for the years 2000-2015 as provided by EL.STAT [10], the highest life expectancy gain was observed for the 60 to 79 years old men and women, followed by the over 80 years old people (data not shown).

In contrast, the fertility rate in Greece has substantially decreased during the past decades. After a relatively constant course until the late 1970s, a downward trend followed (Fig. ​11) with a declining rate of 0.2 units per decade (p<0.001).

3.3. Mortality Trends

Until the late 1980s, CVD and coronary heart disease (CHD) mortality rates were following an increasing course (especially for men) (Fig. ​22). The peak of CVD death rate for men was in 1987 (570 deaths per 100,000 persons) (i.e., 257 CHD deaths per 100,000 persons, 137 stroke deaths plus other forms of cardiovascular diseases). CVD and CHD death rates for women were essentially stable until the early or mid-80s. From 1988 to 2009, this course was reversed with an annual decreasing rate of 9 deaths for both genders (95% CIs: 8.3-10 for men and 8.0-9.2 for women). A new upward course of 13 and 18 deaths annually (per 100,000 persons) for men and women respectively (p<0.001) was recorded during the most recent years (2010-2015). In both genders CHD mortality time trends in Greece over the last 60 years followed the same course as CVD. Stroke deaths were relatively stable until 1970s, followed by a considerable decline until 2009 and a sharp increase afterwards (2010-2015) for both men and women (Fig. ​22). The time trends for all-cause mortality rate differed, since a stable decreasing course was observed from the 1950s and onwards for both genders (Fig. ​22), with an annual decrement of 11 deaths per 100,000 persons for men (95% CIs: 10-11, p<0.001) and 12 deaths for women (95% CIs: 11-12, p<0.001).

3.4. Effects of Mortality and Fertility Time trends on Life Expectancy and Population Aging

Time series analysis showed that, for men, CVD and CHD mortality rates were positively associated with life expectancy at birth until 1987. During 1988-2009 this association was reversed with the reduction in CVD mortality accounting for the 96% in life expectancy rise for men and 97% for women (Table ​22). The decrement in all-cause mortality rate since the 1950s was associated with an annual increase in life expectancy by approximately 0.15 years (p<0.001) for both genders and with a substantial growth in the relative representation of the older age-groups compared with the younger ones (Table ​22). Furthermore, from the early 1970s and onwards, the decrement in fertility rate accounted for the 79% of the 0-15 years age-group shrinkage and for the 43% of the increase in the ratio 65+ to 15-65 years (p<0.001 in both cases).

Table 2

Time-series analysis results that evaluate the effects of mortality and fertility (1956–2015) (independent variables) on life expectancy and population ageing (dependent variables).

GenderTimeLife Expectancy
(in years)
Population Age Distribution
65+ years / 15–65 years ratePercent of 0–15 years
b (95% CI)pR2b (95% CI)pR2b (95% CI)pR2
CVDa Mortality
(per 10 deaths/100.00 people)
Men1956–19870.31 (0.26, 0.36)<0.0010.850.01 (0.004, 0.01)<0.0010.76-0.29 (-0.37, -0.21)<0.0010.68
1988–2009-0.16 (-0.17, -0.14)<0.0010.96-0.01 (-0.005, -0.004)<0.0010.970.31 (0.26, 0.36)<0.0010.89
2010–20150.14 (0.05, 0.22)0.0110.790.01 (0.004, 0.01)0.0010.92-0.01 (-0.04, 0.02)0.4200.17
Women1956–1987-0.68 (-1.0, -0.35)<0.0010.39-0.01 (-0.02, -0.01)<0.0010.640.67 (0.44, 0.89)<0.0010.57
1988–2009-0.22 (-0.24, -0.20)<0.0010.97-0.01 (-0.01, -0.005)<0.0010.970.34 (0.29, 0.39)<0.0010.92
2010–20150.07 (0.01, 0.13)0.0360.640.004 (0.001, 0.01)0.0090.82-0.01 (-0.02, 0.01)0.4590.14
All-cause Mortality
(per 10 deaths/100.00 people)
Men1956–2015-0.14 (-0.15, -0.13)<0.0010.92-0.003 (-0.003, -0.002)<0.0010.900.22 (0.21, 0.23)<0.0010.96
Women1956–2015-0.16 (-0.17, -0.15)<0.0010.95-0.003 (-0.003, -0.002)<0.0010.910.21 (0.20, 0.22)<0.0010.97
Fertility Rate
(per 1 unit/woman)
All1956–19703.7 (0.25, 7.2)0.0390.360.11 (0.01, 0.21)0.0410.32-4.6 (-11, 1.8)0.1410.14
1971–2015-4.6 (-5.5, -3.7)<0.0010.69-0.07 (-0.09, -0.04)<0.0010.438.2 (6.9, 9.5)<0.0010.79

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a CVD: cardiovascular disease. Regression b-coefficients illustrate the effect of CVD or all-cause mortality, and fertility rate (independent variables) on the following outcomes: population life expectancy, the rate of (65+) / (15-65) years old people, and the % of people between 0 – 15 years. For example, among men during 1956-1987, an increase of 10 CVD deaths/100,000 people was associated with: 0.31 years increase in Life Expectancy, 0.01 increase in the rate (65+) / (15-65) years old people and a decrease of 0.15 of the % of people between 0-15 years old.Go to:

4. DISCUSSION

Greece is an aged country with already half of its population >43 years of age while population projections suggest that the aging process will continue in the decades to come, due to fertility and mortality dynamics which favour the increasing of older groups to the detriment of younger ones, but also lead to the reduction of death rates from diseases such as CVD, especially in the older age-groups [1]. Furthermore, the continued prolongation of the life span observed over the last decades, acts cumulatively and aggravates the phenomenon of the aging population.

The Greek population has shown a rapid increase of the elderly people percentage while its median age is currently among the highest in Europe [12]. In 2015, the share of Greeks that had celebrated their 80th birthday (6.3%) was the second highest in EU, very close behind Italy (6.4%) [12]. Simultaneously, life expectancy increased by almost 4 years since the 1990s (although slower than other countries) and by almost 10 years since the 1970s, a figure that gives Greece a World Life Expectancy ranking of 25 among the WHO countries [13]. This phenomenon does not only characterize the Greek population. The vast majority of modern economies are aging; some of them at a fast pace and exhibit lowering fertility rates and increases in life expectancy [1415]. The combined effect of increased longevity and low fertility is responsible for a great part of the population “greying”.

Although Greece was among the last countries to join Europe’s declining fertility course, these late though sharp, falling fertility rates soon reached the lowest levels world-wide. In particular, compared with 1.4 in the 1990s and to 2.20 in the 1980s, in 2015 fertility rate was only 1.3 births/woman, that is far below the value of 2 – which is considered as the replacement rate for a population resulting in relative stability – and is indicative that population is decreasing in size and growing older [16]. According to EUROSTAT [11] estimates, by 2030, the overall size of the Greek population is projected to be smaller, but much older. Although projections are nothing more than projections, based on assumptions, it is currently beyond any doubt that the greying of the Greek population will impose serious financial and social burdens [17].

Prima facie, CVD mortality trends herald optimistic news as death rates have been reduced quite substantially in the last 4 decades, although differentiations have been observed according to the county-region, the statistical method applied and the source of mortality information [1819]. In many European countries, in 2009 death rates from heart disease were <50% as compared with the 1980s [1]. Similar trends have been recorded for stroke and CHD in particular, as expected since they are both a part of the general category of CVD. These declines in CVD mortality have been mainly attributed to the progress made in cardiovascular care and to efficient cardiovascular treatment (e.g. use of statins and better antihypertensive medication) [1], a breakthrough in medical science that was experienced and became strongly perceptible in Greece from the late ‘80s and onwards [20]. Unfortunately, a second and more insightful look raises some justifiable concerns: i) the most recent evidence indicates a renewed increase in CVD mortality rates which seems strongly affected by the undergoing economic crisis, ii) CVD remains the leading cause of death in Greece, responsible for approximately 5 in every 10 deaths (i.e. 48%; 26% for CHD and 22% for stroke) during 2000-2015, whereas 90% of those deaths concerned adults above 60 years old [1013]. Similarly, 32% of the deaths globally were attributable to CVD, making it the leading cause of death worldwide [21], iii) the demographic transition is a major driver of CVD; the same time that death rates have fallen globally by 22%, the raw numbers of CVD deaths have increased by 41% due to the aging and growth of the world’s population [21], iv) substantial differences have been observed between High-Income (HIC) and Low- and Middle-Income Countries (LMIC); from 1990 to 2013, in HICs a 43% decline in CVD death rates has been seen while no significant changes have been observed in the CVD-related number of deaths [21]. On the other hand and during the same period, in LMICs, the decrease in CVD mortality rates was much lower (i.e. only 13%) while being accompanied by a simultaneous increase of the raw numbers in CVD deaths by 66% [21], v) during the last decades, evidence of an increase in diabetes and obesity prevalence among adults has been reported while in some regions similar increases have been observed for smoking, physical inactivity, dyslipidaemia, hypertension and psychological distress (i.e. CVD risk factors) [1342224], vi) it has also been formulated that the current national trends in CVD mortality have masked local increases, especially among younger adults (i.e. below 65 years old) [25], vii) it has been hypothesized that the recorded declining CVD mortality rates are mainly related to the older ages, while the corresponding trends among younger adults seem to be plateauing or even rising as the increase in the prevalence of obesity and diabetes is cancelling the gains from reducing smoking [1] while, as far as premature deaths are concerned, CVD is enhanced steadily, beginning at ages as young as 30-34 years, where it accounted for 11% of all deaths [20], and, viii) notably in Greece, it has been suggested that the recent declining trends in all-cause mortality [26] and in CVD death rate particularly, do not necessarily go hand in hand with corresponding morbidity reductions. This is supported by several facts such as: the increasing environmental pollution that enhances the propagation of adverse pathophysiological processes, linked with atherosclerosis, including genetic, haemodynamic, metabolic, oxidative and inflammation parameters [27]; the observed deviation from the healthy and cardioprotective Mediterranean dietary pattern during the past decades [28]; the increment in the key CVD risk factors that has been discussed earlier; and the phenomenon of population aging and social upheavals clearly suggest that shifts towards the upper part of the age pyramid entail a reshuffling in the disease prevalence [21].

Population aging is a historically unprecedented event that cannot be avoided, deterred or alleviated. Much of this demographic phenomenon is attributed to the progress made towards longevity, which is a great achievement. The same applies to the spectacular progress made in medical and pharmacological science with consequence the substantial decrease in mortality rates. Spectacular though this progress may seem, it is not free from negative side effects. In order to fully exploit these undoubtedly positive steps, for the benefit of society by promoting well-being the side effects arisen must be efficiently and constructively answered, as longer lifespan does not necessarily mean healthier additional years. Life expectancy at 65 is 19 years (for both sexes), while healthy life expectancy is only 8 years. Stated differently, <42% of the remaining years of a 65-year old Greek are expected to be in good health [2930]. An option is to timely prepare societies for the years to come through the restructuring of the health care system, the review of the budgetary constraints and the implementation of innovative ideas. A possible way to successfully cope with the new demographic realities is to unlock an, up till now largely overlooked, opportunity named “healthy aging” which is described by the World Health Organization as a process of developing and maintaining the functional ability that enables well-being in older age [31]. Functional ability is made up of the intrinsic individual’s ability, the environmental characteristics and the interactions between them while well-being theoretically involves the concepts of satisfaction, fulfilment and happiness [31]. Longevity in good health seems today the “comparative advantage” of Europe “vis à vis” all other aging societies [32]. Europeans in their sixties and early seventies are more physically robust, more mentally alert and better educated than ever before [33] but efforts in this direction should be continued and stepped up so that healthy aging can be achieved for the entire population regardless of societal, economic, racial, cultural or religious characteristics. The results of the study can be also interpreted using the classic Omran’s theory of epidemiological transition [34]. Factors involved in the epidemiological transition are demographic changes, biological factors (microorganisms), environmental factors, social, cultural and behavioural factors and the practices of modern medicine [35]. The dominant role of SDH (Social Determinants of Health) in population health status has been widely recognized [36]. In addition, the particular impact of the SDH on CVD, in view of the epidemiological transition, has been documented [37] and thus, due to the recent financial crisis in Greece, further study of the impact of the social conditions on the CVD in the Greek population during the last decade could be considered.

Strengths and limitations: although the present work has documented valuable official data describing mortality and demographic trends and the association between them over a 60-year period, unfortunately no data was available on CVD morbidity or on CVD raw death numbers during the same period.Go to:

CONCLUSION

In light of the projected growing proportion (and number) of old aged population and under the assumption of no major changes in either, risk factors or treatment, CVD prevalence is expected to increase in the decades to come in Greece. The burden of CVD and its cardiometabolic disorders is high, particularly in the urban Greek population, despite the various strategic plans and public health actions developed in the past years. The aforementioned findings underlie the need for emerging and focused prevention strategies in order to reduce the CVD burden at population level, especially in view of the dramatic population aging and the current economic crisis.Go to:

ACKNOWLEDGEMENTS

Declared none.Go to:

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

Not applicable.Go to:

HUMAN AND ANIMAL RIGHTS

No animals/humans were used for studies that are the basis of this research.Go to:

CONSENT FOR PUBLICATION

Not applicable.Go to:

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.Go to:

FUNDING

No funding.Go to:

REFERENCES

1. Nichols M., Townsend N., Scarborough P., Rayner M. Trends in age-specific coronary heart disease mortality in the European Union over three decades: 1980-2009. Eur. Heart J. 2013;34(39):3017–3027. doi: 10.1093/eurheartj/eht159. [PMC free article] [PubMed] [CrossRef] [Google Scholar]2. OECD Health at a Glance 2017 (Available at website http://dx.doi.org/10.1787/health_glance-2017-en, assessed on November 10th, 2017).3. Koloverou E., Panagiotakos D.B., Pitsavos C., Chrysohoou C., Georgousopoulou E.N., Pitaraki E., Metaxa V., Stefanadis C., ATTICA Study Group 10-year incidence of diabetes and associated risk factors in Greece: The ATTICA study (2002-2012). Rev. Diabet. Stud. 2014;11(2):181–189. doi: 10.1900/RDS.2014.11.181. [PMC free article] [PubMed] [CrossRef] [Google Scholar]4. Panagiotakos D.B., Georgousopoulou E.N., Pitsavos C., Chrysohoou C., Metaxa V., Georgiopoulos G.A., Kalogeropoulou K., Tousoulis D., Stefanadis C., ATTICA Study group Ten-year (2002-2012) cardiovascular disease incidence and all-cause mortality, in urban Greek population: the ATTICA Study. Int. J. Cardiol. 2015;180:178–184. doi: 10.1016/j.ijcard.2014.11.206. [PubMed] [CrossRef] [Google Scholar]5. Kollia N., Panagiotakos D.B., Georgousopoulou E., Chrysohoou C., Tousoulis D., Stefanadis C., Papageorgiou C., Pitsavos C. Exploring the association between low socioeconomic status and cardiovascular disease risk in healthy Greeks, in the years of financial crisis (2002-2012): The ATTICA study. Int. J. Cardiol. 2016;223:758–763. doi: 10.1016/j.ijcard.2016.08.294. [PubMed] [CrossRef] [Google Scholar]6. UN Revision of World Population Prospects. Available at https://esa.un.org/unpd/wpp/Download/Standard/Population. 2017.7. Tragaki A. Demographics: The vulnerable heel of the European Achilles. European View. 2014;13(2):277–285. doi: 10.1007/s12290-014-0317-3. [CrossRef] [Google Scholar]8. Scheunemann L.P., White D.B. The ethics and reality of rationing in medicine. Chest. 2011;140(6):1625–1632. doi: 10.1378/chest.11-0622. [PMC free article] [PubMed] [CrossRef] [Google Scholar]9. Strait J.B., Lakatta E.G. Aging-associated cardiovascular changes and their relationship to heart failure. Heart Fail. Clin. 2012;8(1):143–164. doi: 10.1016/j.hfc.2011.08.011. [PMC free article] [PubMed] [CrossRef] [Google Scholar]10. EL. 2016. STAT. Annual data on deaths in Greece by sex, age, and cause of death [electronic resource]. Piraeus: Hellenic Statistical Authority. http://www.statistics.gr/pls/apex/f?p=105:1030:326444671.11. EUROSTAT. Demography/Population on 1 January by age and sex, http://epp.eurostat.ec.europa.eu/portal/page/portal/ statistics/search _database.12. European Commission. The 2015 Ageing Report, Economic and Budgetary projections for the 28 EU Member States. The European Economy Series; 2015. pp. 2013–2060. [Google Scholar]13. World Health Organization (WHO) World Health Statistics Available at http://apps.who.int/ iris/bitstream/10665/ 255336/1/9789241565486-eng.pdf?ua=1. 2017.14. Lutz W., Sanderson W., Scherbov S. The coming acceleration of global population ageing. Nature. 2008;451(7179):716–719. doi: 10.1038/nature06516. [PubMed] [CrossRef] [Google Scholar]15. The World Bank Group. Available at https://data.worldbank.org/indicator/SP.DYN.TFRT.IN/ 2017.16. Bagavos C., Tragaki A. The compositional effect of education and employment on Greek male and female fertility rates during 2000-2014. Demogr. Res. 2017;36(47):1435–1452. doi: 10.4054/DemRes.2017.36.47. [CrossRef] [Google Scholar]17. Committee of the Regions. Opinion of the Committee of the Regions on Dealing with the impact of an ageing population in the EU (2009 Ageing Report) (Opinion No. 2010/C 232/02). Committee of the Regions; 2010. [Google Scholar]18. Araújo C., Pereira M., Viana M., Rocha O.L., Bennett K., Lunet N., Azevedo A. Regional variation in coronary heart disease mortality trends in Portugal, 1981-2012. Int. J. Cardiol. 2016;224:279–285. doi: 10.1016/j.ijcard.2016.09.059. [PubMed] [CrossRef] [Google Scholar]19. Sousa L.V.A., Paiva L.D.S., Figueiredo F.W.D.S., Almeida T.C.D.C., Oliveira F.R., Adami F. Trends in Stroke-Related Mortality in the ABC Region, São Paulo, Brazil: An Ecological Study Between 1997 and 2012. Open Cardiovasc. Med. J. 2017;11:111–119. doi: 10.2174/1874192401711010111. [PMC free article] [PubMed] [CrossRef] [Google Scholar]20. Boudoulas K.D., Triposkiadis F., Stefanadis C., Boudoulas H. The endlessness evolution of medicine, continuous increase in life expectancy and constant role of the physician. Hellenic J. Cardiol. 2017;58(5):322–330. doi: 10.1016/j.hjc.2017.05.001. [PubMed] [CrossRef] [Google Scholar]21. Roth G.A., Huffman M.D., Moran A.E., Feigin V., Mensah G.A., Naghavi M., Murray C.J. Global and regional patterns in cardiovascular mortality from 1990 to 2013. Circulation. 2015;132(17):1667–1678. doi: 10.1161/CIRCULATIONAHA.114.008720. [PubMed] [CrossRef] [Google Scholar]22. Panagiotakos D.B., Pitsavos C., Chrysohoou C., Skoumas I., Stefanadis C. Prevalence and five-year incidence (2001-2006) of cardiovascular disease risk factors in a Greek sample: The ATTICA study. Hellenic J. Cardiol. 2009;50(5):388–395. [PubMed] [Google Scholar]23. Gikas A., Lambadiari V., Sotiropoulos A., Panagiotakos D., Pappas S. Prevalence of major cardiovascular risk factors and coronary heart disease in a sample of greek adults: The saronikos study. Open Cardiovasc. Med. J. 2016;10:69–80. doi: 10.2174/1874192401610010069. [PMC free article] [PubMed] [CrossRef] [Google Scholar]24. Kyrou I., Kollia N., Panagiotakos D., Georgousopoulou E., Chrysohoou C., Tsigos C., Randeva H.S., Yannakoulia M., Stefanadis C., Papageorgiou C., Pitsavos C., ATTICA Study investigators Association of depression and anxiety status with 10-year cardiovascular disease incidence among apparently healthy Greek adults: The ATTICA Study. Eur. J. Prev. Cardiol. 2017;24(2):145–152. doi: 10.1177/2047487316670918. [PubMed] [CrossRef] [Google Scholar]25. Vaughan A.S., Ritchey M.D., Hannan J., Kramer M.R., Casper M. Widespread recent increases in county-level heart disease mortality across age groups. Ann. Epidemiol. 2017;27(12):796–800. doi: 10.1016/j.annepidem.2017.10.012. [PMC free article] [PubMed] [CrossRef] [Google Scholar]26. Chimonas T., Fanouraki I., Liberopoulos E.N., Chimonas E., Elisaf M. Diverging trends in cardiovascular morbidity and mortality in a low risk population. Eur. J. Epidemiol. 2009;24(8):415–423. doi: 10.1007/s10654-009-9362-7. [PubMed] [CrossRef] [Google Scholar]27. Tyrovolas S., Panagiotakos D.B. The role of Mediterranean type of diet on the development of cancer and cardiovascular disease, in the elderly: A systematic review. Maturitas. 2010;65(2):122–130. doi: 10.1016/j.maturitas.2009.07.003. [PubMed] [CrossRef] [Google Scholar]28. Bagavos C. Gender and regional differentials in health expectancy in Greece. J. Public Health Res. 2013;2(2):e12. doi: 10.4081/jphr.2013.e12. [PMC free article] [PubMed] [CrossRef] [Google Scholar]29. Tabassum F., Verropoulou G., Tsimbos C., Gjonca E., Breeze E. Socio-economic inequalities in physical functioning: A comparative study of English and Greek elderly men. Ageing Soc. 2009;29:1123–1140. doi: 10.1017/S0144686X09008812. [CrossRef] [Google Scholar]30. World Health Organization. World report on ageing and health. Geneva, Switzerland: World Health Organization; 2015. [Google Scholar]31. Eberstadt N., Groth H. Europe’s Coming Demographic Challenge: Unlocking the Value of Health, The A.E.I. Press, 2007, Washington D.C. [Google Scholar]32. Commission Staff. Working document on an Action Plan for the EU Health Workforce. Strasbourg: European Commission; 2012. [Google Scholar]33. Omran A.R. The epidemiologic transition. A theory of the epidemiology of population change. Milbank Mem. Fund Q. 1971;49(4):509–538. doi: 10.2307/3349375. [PubMed] [CrossRef] [Google Scholar]34. Wahdan M.H. The epidemiological transition. East. Mediterr. Health J. 1996;2(1):8–20. [Google Scholar]35. WHO. Closing the gap in a generation: Health equity through action on the social determinants of health. 2018. Final Report of the Commission on Social Determinants of Health. World Health Organization, Commission on Social Determinants of Health, Geneva 2008. Available at http://www.who.int/social_determinants/thecommission/finalreport/en/ [PubMed]36. Kreatsoulas C., Anand S.S. The impact of social determinants on cardiovascular disease. Can. J. Cardiol. 2010;26(Suppl. C):8C–13C. doi: 10.1016/S0828-282X(10)71075-8. [PMC free article] [PubMed] [CrossRef] [Google Scholar]37. Cairns B.J., Balkwill A., Canoy D., Green J., Reeves G.K., Beral V., Million Women Study Collaborators Variations in vascular mortality trends, 2001-2010, among 1.3 million women with different lifestyle risk factors for the disease. Eur. J. Prev. Cardiol. 2015;22(12):1626–1634. doi: 10.1177/2047487314563710. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


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Open Cardiovasc Med J. 2018; 12: 71–79.Published online 2018 Jul 31. doi: 10.2174/1874192401812010071PMCID: PMC6080059PMID: 30159093

Trends of Cardiovascular Disease Mortality in Relation to Population Aging in Greece (1956 – 2015)

Natasa Kollia,1Alexandra Tragaki,2Aristomenis I. Syngelakis,3 and Demosthenes Panagiotakos1,4,5,6,*Author informationArticle notesCopyright and License informationDisclaimer1Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece2Department of Geography, School of Environment, Geography and Applied Economics, Harokopio University, Athens, Greece3School of Social Sciences, Hellenic Open University, Patras, Greece4Faculty of Health, University of Canberra, Bruce, Australia5School of Allied Health, College of Science, Health and Engineering, LA TROBE University, Melbourne, Australia6Department of Kinesiology & Health RUTGERS, School of Arts & Life Sciences, The State University of New Jersey, New Brunswick, NJ, USA*Address correspondence to this author at the Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, 17671, Greece; Tel: +30 210-9549332; E-mail: ten.asu@sokatoiganap.b.dThis article has been cited by other articles in PMC.Go to:

Abstract

Background:

Demographic dynamics and decreasing trends in mortality from chronic diseases are major contributors to the phenomenon of population aging. The purpose of the present study was to examine the association between cardiovascular disease (CVD) mortality and demographic indicators, in Greece the past 60 years.

Methods:

Life Expectancy at birth (LE), population age structure, fertility rates (TFR) and all-cause, CVD mortality rates were retrieved (data provided by the Hellenic Statistical Authority, 1956-2015). In order to test the research hypothesis time-series analysis was conducted.

Results:

Increasing trends in LE and in the older age (>65 or >80 years) groups’ share and declining trends in TFR were recorded. CVD mortality, after an upward course, showed decreasing trends during 1988–2009, accounting for the 96% and 97% increment in LE in men and women respectively. However, newer records (2010-2015) show a new upward trend. The declining trends in TFR were highly associated with the shifts towards the upper part of the population age pyramid.

Conclusion:

Population aging is a historically unprecedented event that cannot be avoided, deterred or alleviated. Its negative effects act cumulatively with the recent increases in cardiovascular mortality, especially in the light of the ongoing economic crisis which is expected to further exacerbate the existing contrasts. A possible way to successfully cope with the new demographic realities is to unlock an, up till now largely overlooked, opportunity named “healthy aging”.Keywords: Population aging, Cardiovascular disease, Mortality, Life expectancy, Fertility, Demographic changesGo to:

1. INTRODUCTION

Recent trends in cardiovascular disease (CVD) mortality show remarkable declining rates in European countries and North America [1]. Despite this evidence, CVD is still the number one cause of death in most OECD (Organisation for Economic Co-operation and Development) countries, accounting for more than one-third of all deaths in 2015 [2]. Furthermore, the prevalence of common CVD risk factors like hypertension, obesity, hypercholesterolemia and diabetes have increased [34], especially in younger people [1], implying that cardiometabolic co-morbidity does not necessarily follow mortality trends. Furthermore, since cardiovascular health seems to be highly associated with socioeconomic factors5 and the reduction in CVD mortality over the past years has not been felt equally in all sectors of society – the most impressive improvements in cardiovascular health benefited the richest societal groups and countries [5] – the investigation of the most current CVD mortality trends (i.e. under the context of the ongoing economic crisis) is of particular value.

Alongside, during the last decades, substantial demographic changes have been recorded. Globally, life expectancy at birth has increased by approximately 25 years since the 1950s [6], probably due to the declining mortality rates attributed mainly to the spectacular improvements in health care, in pharmacological and other treatment and in general to the advances in medical science. The increment in life expectancy, while undeniably a major achievement, coupled with falling fertility rates, reshapes population pyramids and shifts volumes towards older age groups, a phenomenon widely known as population aging. Europe is by all means the oldest region of the planet. Currently, half of the European population is over 42 years of age, while 1 out of 4 Europeans is above 60 years of age [7].

Of all areas, health care is particularly sensitive to a population’s age-structure. Increasing shares of elder and old age groups are expected to affect: (i) the demand, (ii) the organization and delivery, and, (iii) the cost of health care systems. In parallel, in the context of the economic crisis, the increased cost of health care for the elderly creates the risk of raising ethical issues concerning rationing in Medicine (the allocation of scarce resources) [8]. Moreover, as longevity allows greater number of persons to reach higher ages, previously uncommon conditions become frequent, if not dominant morbidity causes. Particularly, CVD risk levels increase with age since the key risk factors are either directly age-related – like hypertension, diabetes, elevated cholesterol levels – or have a cumulative harmful effect, like tobacco use, obesity and physical inactivity [9]. Against this challenging demographic background and taking into account that age is one of the most dominant determinants of cardiovascular health, CVDs are expected to remain the leading cause of death in the years to come.

In the context of the aforementioned considerations, this paper aims to examine the effect of the trends in CVD mortality on longevity and on population age structure in Greece, during 1956 – 2015 and to discuss the implications and challenges arising from this favorable, but, also complex phenomenon involving the modern western world.Go to:

2. METHODS

2.1. Official Statistics

Demographic indicators, such as life expectancy at birth (LE), fertility rates (TFR), population age structure (1960-2015) and all-cause, CVD mortality rates (1956-2015) have been calculated using data provided by the Hellenic Statistical Authority (EL.STAT.) [10] and the EUROSTAT (Directorate-General of the European Commission) Population Projections-Baseline scenario [1013].

2.2. Statistical Analysis

Mortality rates were presented per 100,000 persons. Time trends in the demographic indices and in mortality rates were graphically presented (Figs. ​11 and ​22 respectively). Time-series analysis was conducted to evaluate the effect of all-cause and CVD mortality and fertility trends during 1956-2015 (independent determinants) on life expectancy and on the age structure of the Greek population (outcomes), in men and women separately. Due to the presence of a significant interaction between time and the independent variables, a stratified by year analysis was implemented. The estimated b-coefficients along with the 95% confidence intervals, the corresponding p-values and the adjusted R2 were provided. All reported p-values were based on two-sided tests and overall statistical significance level was set at 5%. STATA software, version 14 (MP & Associates, Sparta, Greece) was used for all statistical analyses.

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Open in a separate windowFig. (1)

Demographic time trends in Greece (1956–2015); source: Hellenic Statistics Authority [10].

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Open in a separate windowFig. (2)

Mortality time trends in Greece (1956–2015); source: Hellenic Statistics Authority. CVD: cardiovascular disease; CHD: coronary heart disease. Mortality rates were calculated per 100,000 persons [10].Go to:

3. RESULTS

3.1. Population Aging in Greece

According to the latest official statistics (population estimates 2015), the median age of the Greek population has increased by approximately 10 years since 1970s (i.e. from 32.3 to 43.4 years), and it is expected to further increase in the future (Table ​11). According to the projections provided by EUROSTAT (baseline scenario) [11] by 2030, half of the Greek population will be over 50 years age; more than one-third will be above 65 years and almost 9% will be above 80 years, in contrast to the youngest population segment which will be limited to just 11% (Table ​11). In particular, the group aged 0-14 comprise a rapidly shrinking part of the Greek population; already <20% in the 1990s, their share dropped down to as low as 14.5% in 2015. At the other end of the age spectrum, those above 65 years old currently represent 27% of total population, which is 31% higher than in 2000. The growth rate of those above 80 years old is even more spectacular, as their share more than doubled since the 1990s (Table ​11). The time trends of the Greek population age structure during the last 60 years are presented in Fig. (​11).

Table 1

Population age distribution for the Greek population, during the years 1970–2030.

Year197019801990200020152030a
Total Population, N8,300,3998,780,5149,584,18410,120,89210,775,6279,944,658
<15 years old (%)24.223.119.514.714.511.7
65 – 80 years old (%)11.113.113.717.320.927.2
>80 years old (%)2.02.33.03.56.38.7
Median age (years)323436384350

a EUROSTAT Population Projections according to baseline scenario [11].

3.2. Life Expectancy and fertility Trends

The time trends of life expectancy at birth are similar for both men and women and exhibit a linearly increasing course with men having consistently, approximately 3 years shorter estimates (Fig. ​11). In 2015, life expectancy was increased by 13 years for women and by 11 years for men compared with 1960 with an increasing rate of 0.20 [95% confidence intervals (CIs): 0.20-0.21), p<0.001] and 0.17 (95% CIs: 0.16-0.17, p<0.001) per year, respectively. Using the National Vital Statistics for the years 2000-2015 as provided by EL.STAT [10], the highest life expectancy gain was observed for the 60 to 79 years old men and women, followed by the over 80 years old people (data not shown).

In contrast, the fertility rate in Greece has substantially decreased during the past decades. After a relatively constant course until the late 1970s, a downward trend followed (Fig. ​11) with a declining rate of 0.2 units per decade (p<0.001).

3.3. Mortality Trends

Until the late 1980s, CVD and coronary heart disease (CHD) mortality rates were following an increasing course (especially for men) (Fig. ​22). The peak of CVD death rate for men was in 1987 (570 deaths per 100,000 persons) (i.e., 257 CHD deaths per 100,000 persons, 137 stroke deaths plus other forms of cardiovascular diseases). CVD and CHD death rates for women were essentially stable until the early or mid-80s. From 1988 to 2009, this course was reversed with an annual decreasing rate of 9 deaths for both genders (95% CIs: 8.3-10 for men and 8.0-9.2 for women). A new upward course of 13 and 18 deaths annually (per 100,000 persons) for men and women respectively (p<0.001) was recorded during the most recent years (2010-2015). In both genders CHD mortality time trends in Greece over the last 60 years followed the same course as CVD. Stroke deaths were relatively stable until 1970s, followed by a considerable decline until 2009 and a sharp increase afterwards (2010-2015) for both men and women (Fig. ​22). The time trends for all-cause mortality rate differed, since a stable decreasing course was observed from the 1950s and onwards for both genders (Fig. ​22), with an annual decrement of 11 deaths per 100,000 persons for men (95% CIs: 10-11, p<0.001) and 12 deaths for women (95% CIs: 11-12, p<0.001).

3.4. Effects of Mortality and Fertility Time trends on Life Expectancy and Population Aging

Time series analysis showed that, for men, CVD and CHD mortality rates were positively associated with life expectancy at birth until 1987. During 1988-2009 this association was reversed with the reduction in CVD mortality accounting for the 96% in life expectancy rise for men and 97% for women (Table ​22). The decrement in all-cause mortality rate since the 1950s was associated with an annual increase in life expectancy by approximately 0.15 years (p<0.001) for both genders and with a substantial growth in the relative representation of the older age-groups compared with the younger ones (Table ​22). Furthermore, from the early 1970s and onwards, the decrement in fertility rate accounted for the 79% of the 0-15 years age-group shrinkage and for the 43% of the increase in the ratio 65+ to 15-65 years (p<0.001 in both cases).

Table 2

Time-series analysis results that evaluate the effects of mortality and fertility (1956–2015) (independent variables) on life expectancy and population ageing (dependent variables).

GenderTimeLife Expectancy
(in years)
Population Age Distribution
65+ years / 15–65 years ratePercent of 0–15 years
b (95% CI)pR2b (95% CI)pR2b (95% CI)pR2
CVDa Mortality
(per 10 deaths/100.00 people)
Men1956–19870.31 (0.26, 0.36)<0.0010.850.01 (0.004, 0.01)<0.0010.76-0.29 (-0.37, -0.21)<0.0010.68
1988–2009-0.16 (-0.17, -0.14)<0.0010.96-0.01 (-0.005, -0.004)<0.0010.970.31 (0.26, 0.36)<0.0010.89
2010–20150.14 (0.05, 0.22)0.0110.790.01 (0.004, 0.01)0.0010.92-0.01 (-0.04, 0.02)0.4200.17
Women1956–1987-0.68 (-1.0, -0.35)<0.0010.39-0.01 (-0.02, -0.01)<0.0010.640.67 (0.44, 0.89)<0.0010.57
1988–2009-0.22 (-0.24, -0.20)<0.0010.97-0.01 (-0.01, -0.005)<0.0010.970.34 (0.29, 0.39)<0.0010.92
2010–20150.07 (0.01, 0.13)0.0360.640.004 (0.001, 0.01)0.0090.82-0.01 (-0.02, 0.01)0.4590.14
All-cause Mortality
(per 10 deaths/100.00 people)
Men1956–2015-0.14 (-0.15, -0.13)<0.0010.92-0.003 (-0.003, -0.002)<0.0010.900.22 (0.21, 0.23)<0.0010.96
Women1956–2015-0.16 (-0.17, -0.15)<0.0010.95-0.003 (-0.003, -0.002)<0.0010.910.21 (0.20, 0.22)<0.0010.97
Fertility Rate
(per 1 unit/woman)
All1956–19703.7 (0.25, 7.2)0.0390.360.11 (0.01, 0.21)0.0410.32-4.6 (-11, 1.8)0.1410.14
1971–2015-4.6 (-5.5, -3.7)<0.0010.69-0.07 (-0.09, -0.04)<0.0010.438.2 (6.9, 9.5)<0.0010.79

Open in a separate window

a CVD: cardiovascular disease. Regression b-coefficients illustrate the effect of CVD or all-cause mortality, and fertility rate (independent variables) on the following outcomes: population life expectancy, the rate of (65+) / (15-65) years old people, and the % of people between 0 – 15 years. For example, among men during 1956-1987, an increase of 10 CVD deaths/100,000 people was associated with: 0.31 years increase in Life Expectancy, 0.01 increase in the rate (65+) / (15-65) years old people and a decrease of 0.15 of the % of people between 0-15 years old.Go to:

4. DISCUSSION

Greece is an aged country with already half of its population >43 years of age while population projections suggest that the aging process will continue in the decades to come, due to fertility and mortality dynamics which favour the increasing of older groups to the detriment of younger ones, but also lead to the reduction of death rates from diseases such as CVD, especially in the older age-groups [1]. Furthermore, the continued prolongation of the life span observed over the last decades, acts cumulatively and aggravates the phenomenon of the aging population.

The Greek population has shown a rapid increase of the elderly people percentage while its median age is currently among the highest in Europe [12]. In 2015, the share of Greeks that had celebrated their 80th birthday (6.3%) was the second highest in EU, very close behind Italy (6.4%) [12]. Simultaneously, life expectancy increased by almost 4 years since the 1990s (although slower than other countries) and by almost 10 years since the 1970s, a figure that gives Greece a World Life Expectancy ranking of 25 among the WHO countries [13]. This phenomenon does not only characterize the Greek population. The vast majority of modern economies are aging; some of them at a fast pace and exhibit lowering fertility rates and increases in life expectancy [1415]. The combined effect of increased longevity and low fertility is responsible for a great part of the population “greying”.

Although Greece was among the last countries to join Europe’s declining fertility course, these late though sharp, falling fertility rates soon reached the lowest levels world-wide. In particular, compared with 1.4 in the 1990s and to 2.20 in the 1980s, in 2015 fertility rate was only 1.3 births/woman, that is far below the value of 2 – which is considered as the replacement rate for a population resulting in relative stability – and is indicative that population is decreasing in size and growing older [16]. According to EUROSTAT [11] estimates, by 2030, the overall size of the Greek population is projected to be smaller, but much older. Although projections are nothing more than projections, based on assumptions, it is currently beyond any doubt that the greying of the Greek population will impose serious financial and social burdens [17].

Prima facie, CVD mortality trends herald optimistic news as death rates have been reduced quite substantially in the last 4 decades, although differentiations have been observed according to the county-region, the statistical method applied and the source of mortality information [1819]. In many European countries, in 2009 death rates from heart disease were <50% as compared with the 1980s [1]. Similar trends have been recorded for stroke and CHD in particular, as expected since they are both a part of the general category of CVD. These declines in CVD mortality have been mainly attributed to the progress made in cardiovascular care and to efficient cardiovascular treatment (e.g. use of statins and better antihypertensive medication) [1], a breakthrough in medical science that was experienced and became strongly perceptible in Greece from the late ‘80s and onwards [20]. Unfortunately, a second and more insightful look raises some justifiable concerns: i) the most recent evidence indicates a renewed increase in CVD mortality rates which seems strongly affected by the undergoing economic crisis, ii) CVD remains the leading cause of death in Greece, responsible for approximately 5 in every 10 deaths (i.e. 48%; 26% for CHD and 22% for stroke) during 2000-2015, whereas 90% of those deaths concerned adults above 60 years old [1013]. Similarly, 32% of the deaths globally were attributable to CVD, making it the leading cause of death worldwide [21], iii) the demographic transition is a major driver of CVD; the same time that death rates have fallen globally by 22%, the raw numbers of CVD deaths have increased by 41% due to the aging and growth of the world’s population [21], iv) substantial differences have been observed between High-Income (HIC) and Low- and Middle-Income Countries (LMIC); from 1990 to 2013, in HICs a 43% decline in CVD death rates has been seen while no significant changes have been observed in the CVD-related number of deaths [21]. On the other hand and during the same period, in LMICs, the decrease in CVD mortality rates was much lower (i.e. only 13%) while being accompanied by a simultaneous increase of the raw numbers in CVD deaths by 66% [21], v) during the last decades, evidence of an increase in diabetes and obesity prevalence among adults has been reported while in some regions similar increases have been observed for smoking, physical inactivity, dyslipidaemia, hypertension and psychological distress (i.e. CVD risk factors) [1342224], vi) it has also been formulated that the current national trends in CVD mortality have masked local increases, especially among younger adults (i.e. below 65 years old) [25], vii) it has been hypothesized that the recorded declining CVD mortality rates are mainly related to the older ages, while the corresponding trends among younger adults seem to be plateauing or even rising as the increase in the prevalence of obesity and diabetes is cancelling the gains from reducing smoking [1] while, as far as premature deaths are concerned, CVD is enhanced steadily, beginning at ages as young as 30-34 years, where it accounted for 11% of all deaths [20], and, viii) notably in Greece, it has been suggested that the recent declining trends in all-cause mortality [26] and in CVD death rate particularly, do not necessarily go hand in hand with corresponding morbidity reductions. This is supported by several facts such as: the increasing environmental pollution that enhances the propagation of adverse pathophysiological processes, linked with atherosclerosis, including genetic, haemodynamic, metabolic, oxidative and inflammation parameters [27]; the observed deviation from the healthy and cardioprotective Mediterranean dietary pattern during the past decades [28]; the increment in the key CVD risk factors that has been discussed earlier; and the phenomenon of population aging and social upheavals clearly suggest that shifts towards the upper part of the age pyramid entail a reshuffling in the disease prevalence [21].

Population aging is a historically unprecedented event that cannot be avoided, deterred or alleviated. Much of this demographic phenomenon is attributed to the progress made towards longevity, which is a great achievement. The same applies to the spectacular progress made in medical and pharmacological science with consequence the substantial decrease in mortality rates. Spectacular though this progress may seem, it is not free from negative side effects. In order to fully exploit these undoubtedly positive steps, for the benefit of society by promoting well-being the side effects arisen must be efficiently and constructively answered, as longer lifespan does not necessarily mean healthier additional years. Life expectancy at 65 is 19 years (for both sexes), while healthy life expectancy is only 8 years. Stated differently, <42% of the remaining years of a 65-year old Greek are expected to be in good health [2930]. An option is to timely prepare societies for the years to come through the restructuring of the health care system, the review of the budgetary constraints and the implementation of innovative ideas. A possible way to successfully cope with the new demographic realities is to unlock an, up till now largely overlooked, opportunity named “healthy aging” which is described by the World Health Organization as a process of developing and maintaining the functional ability that enables well-being in older age [31]. Functional ability is made up of the intrinsic individual’s ability, the environmental characteristics and the interactions between them while well-being theoretically involves the concepts of satisfaction, fulfilment and happiness [31]. Longevity in good health seems today the “comparative advantage” of Europe “vis à vis” all other aging societies [32]. Europeans in their sixties and early seventies are more physically robust, more mentally alert and better educated than ever before [33] but efforts in this direction should be continued and stepped up so that healthy aging can be achieved for the entire population regardless of societal, economic, racial, cultural or religious characteristics. The results of the study can be also interpreted using the classic Omran’s theory of epidemiological transition [34]. Factors involved in the epidemiological transition are demographic changes, biological factors (microorganisms), environmental factors, social, cultural and behavioural factors and the practices of modern medicine [35]. The dominant role of SDH (Social Determinants of Health) in population health status has been widely recognized [36]. In addition, the particular impact of the SDH on CVD, in view of the epidemiological transition, has been documented [37] and thus, due to the recent financial crisis in Greece, further study of the impact of the social conditions on the CVD in the Greek population during the last decade could be considered.

Strengths and limitations: although the present work has documented valuable official data describing mortality and demographic trends and the association between them over a 60-year period, unfortunately no data was available on CVD morbidity or on CVD raw death numbers during the same period.Go to:

CONCLUSION

In light of the projected growing proportion (and number) of old aged population and under the assumption of no major changes in either, risk factors or treatment, CVD prevalence is expected to increase in the decades to come in Greece. The burden of CVD and its cardiometabolic disorders is high, particularly in the urban Greek population, despite the various strategic plans and public health actions developed in the past years. The aforementioned findings underlie the need for emerging and focused prevention strategies in order to reduce the CVD burden at population level, especially in view of the dramatic population aging and the current economic crisis.Go to:

ACKNOWLEDGEMENTS

Declared none.Go to:

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

Not applicable.Go to:

HUMAN AND ANIMAL RIGHTS

No animals/humans were used for studies that are the basis of this research.Go to:

CONSENT FOR PUBLICATION

Not applicable.Go to:

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.Go to:

FUNDING

No funding.Go to:

REFERENCES

1. Nichols M., Townsend N., Scarborough P., Rayner M. Trends in age-specific coronary heart disease mortality in the European Union over three decades: 1980-2009. Eur. Heart J. 2013;34(39):3017–3027. doi: 10.1093/eurheartj/eht159. [PMC free article] [PubMed] [CrossRef] [Google Scholar]2. OECD Health at a Glance 2017 (Available at website http://dx.doi.org/10.1787/health_glance-2017-en, assessed on November 10th, 2017).3. Koloverou E., Panagiotakos D.B., Pitsavos C., Chrysohoou C., Georgousopoulou E.N., Pitaraki E., Metaxa V., Stefanadis C., ATTICA Study Group 10-year incidence of diabetes and associated risk factors in Greece: The ATTICA study (2002-2012). Rev. Diabet. Stud. 2014;11(2):181–189. doi: 10.1900/RDS.2014.11.181. [PMC free article] [PubMed] [CrossRef] [Google Scholar]4. Panagiotakos D.B., Georgousopoulou E.N., Pitsavos C., Chrysohoou C., Metaxa V., Georgiopoulos G.A., Kalogeropoulou K., Tousoulis D., Stefanadis C., ATTICA Study group Ten-year (2002-2012) cardiovascular disease incidence and all-cause mortality, in urban Greek population: the ATTICA Study. Int. J. Cardiol. 2015;180:178–184. doi: 10.1016/j.ijcard.2014.11.206. [PubMed] [CrossRef] [Google Scholar]5. Kollia N., Panagiotakos D.B., Georgousopoulou E., Chrysohoou C., Tousoulis D., Stefanadis C., Papageorgiou C., Pitsavos C. Exploring the association between low socioeconomic status and cardiovascular disease risk in healthy Greeks, in the years of financial crisis (2002-2012): The ATTICA study. Int. J. Cardiol. 2016;223:758–763. doi: 10.1016/j.ijcard.2016.08.294. [PubMed] [CrossRef] [Google Scholar]6. UN Revision of World Population Prospects. Available at https://esa.un.org/unpd/wpp/Download/Standard/Population. 2017.7. Tragaki A. Demographics: The vulnerable heel of the European Achilles. European View. 2014;13(2):277–285. doi: 10.1007/s12290-014-0317-3. [CrossRef] [Google Scholar]8. Scheunemann L.P., White D.B. The ethics and reality of rationing in medicine. Chest. 2011;140(6):1625–1632. doi: 10.1378/chest.11-0622. [PMC free article] [PubMed] [CrossRef] [Google Scholar]9. Strait J.B., Lakatta E.G. Aging-associated cardiovascular changes and their relationship to heart failure. Heart Fail. Clin. 2012;8(1):143–164. doi: 10.1016/j.hfc.2011.08.011. [PMC free article] [PubMed] [CrossRef] [Google Scholar]10. EL. 2016. STAT. Annual data on deaths in Greece by sex, age, and cause of death [electronic resource]. Piraeus: Hellenic Statistical Authority. http://www.statistics.gr/pls/apex/f?p=105:1030:326444671.11. EUROSTAT. Demography/Population on 1 January by age and sex, http://epp.eurostat.ec.europa.eu/portal/page/portal/ statistics/search _database.12. European Commission. The 2015 Ageing Report, Economic and Budgetary projections for the 28 EU Member States. The European Economy Series; 2015. pp. 2013–2060. [Google Scholar]13. World Health Organization (WHO) World Health Statistics Available at http://apps.who.int/ iris/bitstream/10665/ 255336/1/9789241565486-eng.pdf?ua=1. 2017.14. Lutz W., Sanderson W., Scherbov S. The coming acceleration of global population ageing. Nature. 2008;451(7179):716–719. doi: 10.1038/nature06516. [PubMed] [CrossRef] [Google Scholar]15. The World Bank Group. Available at https://data.worldbank.org/indicator/SP.DYN.TFRT.IN/ 2017.16. Bagavos C., Tragaki A. The compositional effect of education and employment on Greek male and female fertility rates during 2000-2014. Demogr. Res. 2017;36(47):1435–1452. doi: 10.4054/DemRes.2017.36.47. [CrossRef] [Google Scholar]17. Committee of the Regions. Opinion of the Committee of the Regions on Dealing with the impact of an ageing population in the EU (2009 Ageing Report) (Opinion No. 2010/C 232/02). Committee of the Regions; 2010. [Google Scholar]18. Araújo C., Pereira M., Viana M., Rocha O.L., Bennett K., Lunet N., Azevedo A. Regional variation in coronary heart disease mortality trends in Portugal, 1981-2012. Int. J. Cardiol. 2016;224:279–285. doi: 10.1016/j.ijcard.2016.09.059. [PubMed] [CrossRef] [Google Scholar]19. Sousa L.V.A., Paiva L.D.S., Figueiredo F.W.D.S., Almeida T.C.D.C., Oliveira F.R., Adami F. Trends in Stroke-Related Mortality in the ABC Region, São Paulo, Brazil: An Ecological Study Between 1997 and 2012. Open Cardiovasc. Med. J. 2017;11:111–119. doi: 10.2174/1874192401711010111. [PMC free article] [PubMed] [CrossRef] [Google Scholar]20. Boudoulas K.D., Triposkiadis F., Stefanadis C., Boudoulas H. The endlessness evolution of medicine, continuous increase in life expectancy and constant role of the physician. Hellenic J. Cardiol. 2017;58(5):322–330. doi: 10.1016/j.hjc.2017.05.001. [PubMed] [CrossRef] [Google Scholar]21. Roth G.A., Huffman M.D., Moran A.E., Feigin V., Mensah G.A., Naghavi M., Murray C.J. Global and regional patterns in cardiovascular mortality from 1990 to 2013. Circulation. 2015;132(17):1667–1678. doi: 10.1161/CIRCULATIONAHA.114.008720. [PubMed] [CrossRef] [Google Scholar]22. Panagiotakos D.B., Pitsavos C., Chrysohoou C., Skoumas I., Stefanadis C. Prevalence and five-year incidence (2001-2006) of cardiovascular disease risk factors in a Greek sample: The ATTICA study. Hellenic J. Cardiol. 2009;50(5):388–395. [PubMed] [Google Scholar]23. Gikas A., Lambadiari V., Sotiropoulos A., Panagiotakos D., Pappas S. Prevalence of major cardiovascular risk factors and coronary heart disease in a sample of greek adults: The saronikos study. Open Cardiovasc. Med. J. 2016;10:69–80. doi: 10.2174/1874192401610010069. [PMC free article] [PubMed] [CrossRef] [Google Scholar]24. Kyrou I., Kollia N., Panagiotakos D., Georgousopoulou E., Chrysohoou C., Tsigos C., Randeva H.S., Yannakoulia M., Stefanadis C., Papageorgiou C., Pitsavos C., ATTICA Study investigators Association of depression and anxiety status with 10-year cardiovascular disease incidence among apparently healthy Greek adults: The ATTICA Study. Eur. J. Prev. Cardiol. 2017;24(2):145–152. doi: 10.1177/2047487316670918. [PubMed] [CrossRef] [Google Scholar]25. Vaughan A.S., Ritchey M.D., Hannan J., Kramer M.R., Casper M. Widespread recent increases in county-level heart disease mortality across age groups. Ann. Epidemiol. 2017;27(12):796–800. doi: 10.1016/j.annepidem.2017.10.012. [PMC free article] [PubMed] [CrossRef] [Google Scholar]26. Chimonas T., Fanouraki I., Liberopoulos E.N., Chimonas E., Elisaf M. Diverging trends in cardiovascular morbidity and mortality in a low risk population. Eur. J. Epidemiol. 2009;24(8):415–423. doi: 10.1007/s10654-009-9362-7. [PubMed] [CrossRef] [Google Scholar]27. Tyrovolas S., Panagiotakos D.B. The role of Mediterranean type of diet on the development of cancer and cardiovascular disease, in the elderly: A systematic review. Maturitas. 2010;65(2):122–130. doi: 10.1016/j.maturitas.2009.07.003. [PubMed] [CrossRef] [Google Scholar]28. Bagavos C. Gender and regional differentials in health expectancy in Greece. J. Public Health Res. 2013;2(2):e12. doi: 10.4081/jphr.2013.e12. [PMC free article] [PubMed] [CrossRef] [Google Scholar]29. Tabassum F., Verropoulou G., Tsimbos C., Gjonca E., Breeze E. Socio-economic inequalities in physical functioning: A comparative study of English and Greek elderly men. Ageing Soc. 2009;29:1123–1140. doi: 10.1017/S0144686X09008812. [CrossRef] [Google Scholar]30. World Health Organization. World report on ageing and health. Geneva, Switzerland: World Health Organization; 2015. [Google Scholar]31. Eberstadt N., Groth H. Europe’s Coming Demographic Challenge: Unlocking the Value of Health, The A.E.I. Press, 2007, Washington D.C. [Google Scholar]32. Commission Staff. Working document on an Action Plan for the EU Health Workforce. Strasbourg: European Commission; 2012. [Google Scholar]33. Omran A.R. The epidemiologic transition. A theory of the epidemiology of population change. Milbank Mem. Fund Q. 1971;49(4):509–538. doi: 10.2307/3349375. [PubMed] [CrossRef] [Google Scholar]34. Wahdan M.H. The epidemiological transition. East. Mediterr. Health J. 1996;2(1):8–20. [Google Scholar]35. WHO. Closing the gap in a generation: Health equity through action on the social determinants of health. 2018. Final Report of the Commission on Social Determinants of Health. World Health Organization, Commission on Social Determinants of Health, Geneva 2008. Available at http://www.who.int/social_determinants/thecommission/finalreport/en/ [PubMed]36. Kreatsoulas C., Anand S.S. The impact of social determinants on cardiovascular disease. Can. J. Cardiol. 2010;26(Suppl. C):8C–13C. doi: 10.1016/S0828-282X(10)71075-8. [PMC free article] [PubMed] [CrossRef] [Google Scholar]37. Cairns B.J., Balkwill A., Canoy D., Green J., Reeves G.K., Beral V., Million Women Study Collaborators Variations in vascular mortality trends, 2001-2010, among 1.3 million women with different lifestyle risk factors for the disease. Eur. J. Prev. Cardiol. 2015;22(12):1626–1634. doi: 10.1177/2047487314563710. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


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