hidden

How to Protect Your Aging Heart

“Man is as old as his arteries.” –Thomas Sydenham

Cardiovascular diseases are commonly associated with unhealthy lifestyles. Do you know that age is a strong predictor of cardiovascular diseases in both men and women? As you grow older, your risks of suffering a heart attack, to have a stroke, or to develop coronary heart disease and heart failure are getting much higher. Ageing research has been evolving rapidly in the recent decades. In the early days, ageing research was mostly focused on Alzheimer’s disease and related dementias. To improve quality of life in ageing population, other symptoms of ageing including physiological function decline start to capture scientific community’s attention. In AHA Scientific Sessions 2021, a panel of experts and professionals in the field talked about novel strategies to promote healthy vascular aging.

To prevent cardiovascular diseases in aging populations, there are many take-home messages from today’s live session. Dr. Blumenthal from Johns Hopkins University used a simple “ABCDEF” approach1 to highlight the most recent development in cardiovascular diseases management based on most recent scientific discoveries and epidemiological results. Two of the major factors: Diet and Exercise, which are closely associated with body weight management, are further elaborated by Drs. Willett and Donato, respectively.

Dr. Willett is a professor of Epidemiology and Nutrition from Harvard Medical School. He challenged the recommendation of Dietary Guidelines for Americans (DGA). Dr. Willett encouraged the public to focus on evidence-based dietary recommendation, and to evaluate epidemiological studies by using randomized control trials with risk factor, disease incidence and mortality outcomes and prospective epidemiological studies with equal intensity intervention of 12-month and longer. Aside from canonical discussion of dietary recommendation based on health benefits, Dr. Willett raised a pertinent point in environmental sustainability. “How to feed 2 billion people in 2050?” he asked. Climate change is a global crisis and agriculture plays a pivotal role in fighting it. In “the Omnivore’s Dilemma”, Michael Pollan talked about how livestock production is responsible for much of the carbon footprint of global agriculture. The best practice for specific diets to prolong healthy life needs to take into consideration of reducing carbon footprint.

Vascular ageing is comprised of multiple processes including cellular senescence, inflammation and oxidative stress2. Dr. Donato talked about how ageing affects endothelial cell function and habitual aerobic exercise improves endothelial function in men. He also raised an interesting point: this beneficial effect of exercise on endothelial function is sex dependent. More research on sex differences needs to help us understand how to promote healthy ageing. DNA damage is associated with vascular aging. Dr. Shanahan discussed the signaling pathways involving in DNA damage and cellular senescence-associated phenotypes on vascular calcification. Inhibition of DNA damage agents can mediate vascular calcification progression. Can we use DNA damage as a biomarker to detect vascular ageing?

The “One-size-fits-for-all” approach in disease prevention and treatment requires a new perspective. In 2015, Precision Medicine Initiative was launched to accelerate research in disease treatment and prevention by considering individual differences in people’s genes, environments and lifestyles. With the development of next-generation sequencing, risk factors for coronary artery diseases require a modification. Dr. Wolford discussed her research on incorporating genetic backgrounds for disease prediction using polygenic risk scores3. It’s only the beginning of an exciting era using precision medicine as a tool for disease prevention and intervention in cardiovascular diseases.

To protect an aging heart, many approaches need to be implemented. Healthy lifestyles, nice environment and consideration of individual differences are all part of a clue.

REFERENCE

  1. Feldman DI, Wu KC, Hays AG, Marvel FA, Martin SS, Blumenthal RS, Sharma G. The Johns Hopkins Ciccarone Center’s expanded ‘ABC’s approach to highlight 2020 updates in cardiovascular disease prevention. American Journal of Preventive Cardiology. 2021;6:100181.
  2. Donato AJ, Machin DR, Lesniewski LA. Mechanisms of Dysfunction in the Aging Vasculature and Role in Age-Related Disease. Circulation Research. 2018;123(7):825–848.
  3. Wolford BN, Surakka I, Graham SE, Nielsen JB, Zhou W, Gabrielsen ME, Skogholt AH, Brumpton BM, Douville N, Hornsby WE, Fritsche LG, Boehnke M, Lee S, Kang HM, Hveem K, et al. Utility of family history in disease prediction in the era of polygenic scores. medRxiv. 2021:2021.06.25.21259158.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

hidden

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:

  1. 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.
  2. 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?
  3. 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.
  4. 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.
  5. 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.

 

References:

  1. https://www.heart.org/en/healthy-living/healthy-lifestyle/my-life-check–lifes-simple-7
  2. https://doi.org/10.1101/2021.06.25.21259158
  3. Vascular calcification and osteoporosis—from clinical observation towards molecular understanding | SpringerLink
  4. Poly(ADP-Ribose) Links the DNA Damage Response and Biomineralization (cell.com)
  5. Options for keeping the food system within environmental limits | Nature
  6. Cellular and molecular biology of aging endothelial cells – PubMed (nih.gov)
  7. Aging and Exercise: Habitual aerobic exercise does not protect against micro- or macrovascular endothelial dysfunction in healthy estrogen-deficient postmenopausal women (nih.gov)
  8. 2019 Updated Cardiovascular Disease Prevention Guidelines Announced – Johns Hopkins Medicine

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”