Age increases the risk of pericarditis primarily due to changes in the immune system, accumulation of cellular mutations, and the higher likelihood of underlying health conditions that come with aging. As people grow older, their bodies undergo several biological and physiological changes that make the pericardium—the thin sac surrounding the heart—more vulnerable to inflammation.
One key factor is the phenomenon called clonal hematopoiesis of indeterminate potential (CHIP), which becomes more common with age. CHIP involves the expansion of blood cell clones carrying mutations in certain genes, such as DNMT3A and TET2. These mutated cells can promote inflammation and have been strongly linked to an increased risk of inflammatory heart conditions, including pericarditis and myocarditis. This means that as people age, the presence of these mutated blood cells can trigger or worsen inflammation in the heart’s protective layers, raising the risk of pericarditis.
Additionally, the immune system’s function changes with age. Older adults often experience a state called immunosenescence, where the immune response becomes less effective and more prone to dysregulation. This can lead to a higher susceptibility to infections, including viral infections that commonly cause pericarditis. Viruses such as influenza, herpes simplex, and others can more easily infect or reactivate in older individuals, causing inflammation of the pericardium.
Age also brings a greater chance of chronic diseases and conditions that can contribute to pericarditis. For example, autoimmune diseases like lupus or rheumatoid arthritis, which can cause inflammation throughout the body including the pericardium, tend to be more prevalent or have more severe effects in older adults. Kidney failure and metabolic disorders, which are more common with advancing age, can also increase the risk by promoting systemic inflammation or fluid imbalances that affect the heart.
Furthermore, older adults are more likely to have experienced heart attacks or undergone heart surgery, both of which can lead to pericarditis. After a heart attack, the damaged heart tissue can irritate the pericardium, causing inflammation sometimes weeks later in a condition known as Dressler’s syndrome. Surgical procedures on the heart or chest can similarly provoke inflammation of the pericardium as part of the healing process or due to immune reactions.
Physical fitness and cardiovascular health also decline with age, which indirectly raises the risk of pericarditis. Lower aerobic fitness is linked to a higher burden of heart rhythm abnormalities and cardiovascular stress, which can exacerbate inflammation or impair the heart’s ability to recover from insults that might trigger pericarditis.
In summary, aging increases the risk of pericarditis through a combination of genetic changes in blood cells that promote inflammation, a less robust and more dysregulated immune system, higher prevalence of infections and chronic inflammatory diseases, and increased exposure to heart-related injuries or surgeries. These factors together make the pericardium more susceptible to inflammation and damage as people grow older.