The mechanisms for decreased tolerance to ischemia in the aging hearts have not been fully explored but they appear to be multifactorial. The elderly patients most often meet classification of “no-option” patients who suffer from symptoms of chronic recurrent myocardial ischemia without good options for intervention. As such these patients are in greatest need of alternative therapies for revascularization such as angiogenesis. Not only does aging and their co-morbid conditions such as hypercholesterolemia and diabetes impair the endogenous angiogenesis response but there may be decreased responsiveness to exogenous angiogenic therapies. Enhancing the effectiveness of angiogenic therapy in this ever increasing subgroup of cardiovascular patients is as yet unmet. One such promising avenue involves sirtuins. Herein, we review the effect of aging on the processes of angiogenesis and explore the implications for successful clinical treatment of myocardial ischemia with angiogenesis therapy, with particular focus on modification of sirtuins and their targets by resveratrol along with some recent patents.
Keywords: Chronic recurrent myocardial ischemia, revascularization, angiogenesis, hypercholesterolemia, exogenous angiogenic therapies, resveratrol and sirtuins