A Few New Thoughts on the Road to Younger Arteries

If you didn’t tune into #AHA21 “Novel Strategies to Promote Healthy Vascular Aging,” you missed an exciting area of health and wellness that many of us care about: how can we and our patients live longer with reduced cardiovascular disease burden? The AHA makes it “simple” with Life’s Simple 7 that includes 1) managing blood pressure, 2) controlling cholesterol, 3) reducing blood sugar, 4) getting active, 5) eating better, 6) losing weight, and 7) cessation of smoking¹. However, this session on novel strategies provides additional directions to our roadmap to healthier arteries:

Adding a polygenic risk score to our current assessment of cardiovascular risk offers significant improvement in predicting CV events². By capturing more patients using precision medicine as Dr. Brooke Wolford presented, we can initiate lifestyle modification and statins earlier and reduce the rising rates in cardiovascular related deaths.
When vascular smooth muscle cells are exposed to continuous damaging stressors (aging, diabetes, CKD), they become osteogenic-like cells that undergo apoptosis and osteogenic differentiation which leads to more mineralization and calcification of the vascular wall³. While statins can increase coronary calcification, they get rid of the lipid in the plaque which leads to less risk of rupture. The question that remains to be answered is what does the calcium score reflect with regard to other clinical outcomes?
Dr. Catherine Shanahan eloquently presented that inhibitors of DNA-damage used in cancer treatment are also key drivers in mitigating vascular calcification⁴. If these drugs can prove safe in the future, they could be promising in the anti-aging of arteries. For now, lifestyle modifications such as dietary phosphorous have been implicated in premature aging. Do you know what foods have high dietary phosphorus? Processed foods.
Do you know what a flexitarian diet is? Dr. Walter Willett presented the EAT-Lancet Commission’s challenge of feeding 9.8 billion people by 2050 with a healthy AND environmentally sustainable diet. His explanation of this planet friendly, flexitarian diet is quite simple: 1 serving of dairy + 1 (optional) serving of other animal source foods (fish, poultry, eggs, red meat) per day⁵. The base of the flexitarian diet consists of nuts, soy, beans, fruit, vegetables, whole grains, and plant oils.
The combination of aging and being sedentary promotes a reduction in nitric oxide and an increase in superoxides and oxidative stress. As a result, suppression of endothelial function propagates cardiovascular disease. Dr. Anthony Donato’s research found that habitual aerobic exercise in older men prevents the decline in endothelial dependent dilation⁶. Post-menopausal women, however, did not derive the same benefit from exercise unless they were on hormonal therapy⁷. In essence, habitual exercise and its modulation on endothelial senescence is most likely sex and hormone-dependent.

There were additional highlights during this session that included the ABCDE’s of primary prevention presented by Dr. Roger Blumenthal that form the backbone of health and longevity⁸.

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