The following is a list of research implications.
1. The processes that occur in the aging heart require intensive studies. As outlined earlier, the population of individuals 75 years and older is increasing and the incidence of heart failure and atrial fibrillation are increasing by leaps and bounds. The pathophysiology of the aging heart needs to be clarified. These answers will surely result in improvement and changes in therapeutic strategies.
2. It may be possible to prevent collagen degeneration and the fibrosis that stiffens the left ventricular muscle wall. Agents such as spironolactone cause a more complete block of aldosterone production than is achieved with angiotensin-converting enzyme (ACE) inhibition and reduce mortality and morbidity in patients with heart failure. The salutary effects are not only related to sodium and water loss by this mild diuretic, but also to a decrease in cardiac fibrosis, retardation of endothelial dysfunction, and increased nitric oxide vasodilator pro¬duction. Tissue collagen turnover and fibrosis appear to be important facets of heart failure. Spironolactone may attenuate deleterious structural remodeling in the aging heart. A derivative compound, eplerenone (Inspra), has fewer adverse effects when compared with spironolac-tone and has been shown in a well-run randomized clinical trial to be an effective antihypertensive agent.

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