Clinical Scorecard: Metabolic Changes Associated with Aging Alter Intercellular Interactions via the Gut–Liver–Heart Axis and May Contribute to Coronary Artery Disease: The Critical Function of Bile Acid Metabolism

At a Glance

Key Highlights

• CAD is the leading cause of cardiovascular mortality worldwide.
• Aging is a strong and independent risk factor for CAD.
• Cellular senescence contributes to chronic low-grade systemic inflammation.
• Endothelial dysfunction and large-artery stiffness are key vascular phenotypes of aging.
• Dysregulated bile acid metabolism is crucial in the gut–liver–heart axis.

Guideline-Based Recommendations

Diagnosis

• Consider age as a significant risk factor in CAD assessment.

Management

• Explore microbiota remodeling and FXR/TGR5 agonists as potential interventions.

Monitoring & Follow-up

• Monitor for signs of endothelial dysfunction and systemic inflammation in older adults.

Risks

• Increased risk of CAD despite controlled classical risk factors in older populations.

Patient & Prescribing Data

Older adults with CAD or at high risk for CAD.

Emerging therapies include senolytic therapies and metformin, though evidence is primarily preclinical.

Clinical Best Practices

• Integrate multi-omics approaches to understand CAD as a systemic process.
• Assess gut microbiota composition in older adults for potential cardiovascular implications.
• Utilize integrated biomarker frameworks for early risk stratification in CAD.

Related Resources & Content

• Global Burden of Disease Study 2019
• American Heart Association 2023 Statistical Update