Protecting the Aging Heart

Health & Wellness, Relationships

Advanced age is a well-established risk factor for heart disease and its complications. This occurs in large part because 3 out of every 4 men and women aged 65 years and older have at least 1 major risk factor for heart disease. They are as follows: a history of cigarette smoking, diabetes mellitus, hypertension and elevated LDL cholesterol levels. And while death rates from heart disease have been significantly reduced since the 1960s, the one age group where less progress has been made are in men and women 65 years and older. In fact, rates of cardiovascular disease (heart attacks and strokes) with advanced age is expected to double over the next 2-3 decades, unless risk factors are better controlled. The good news is that older hearts can age gracefully as demonstrated in societies such as in Okinawa, Japan where rates of heart attack and stroke have traditionally been low due to healthy lifestyle and excellent social engagement.

This blog will explore ways that older men and women can protect their aging hearts by taking better control of their risk factors. Even if you have multiple risk factors or have experienced a cardiovascular event, it is never too late to intervene in this process and improve your cardiovascular health. You can also check out the recent interviews that my colleagues and I did for Medscape where this topic is discussed in greater detail.

Cigarette Smoking: Because a history of cigarette smoking can shave 10 years off of your life, efforts directed at complete smoking cessation (without switching to vaping) may help to offset risk. Some useful non-pharmacologic tools include hypnotherapy, acupuncture and behavioral counseling. The Nicotrol® inhaler has been the most successful tool in my practice as it most closely simulates the act of cigarette smoking (as compared to nicotine gum or nicotine patches). Other smoking cessation aids that have been effective in my practice are Zyban® and Chantix.®. Always check with your physician to determine what smoking cessation strategies might work best for you.

Diabetes Mellitus: A normal fasting glucose is less than 100 mg/dL with “prediabetes” defined by fasting glucose levels between 100-125 mg/dL and diabetes defined as at least 2 fasting levels exceeding 125 mg/dL. If you have prediabetes, you may be able to reduce conversion to diabetes by losing 5-10% of your body weight. Similarly, if you have early stage diabetes, you may also be able to move your metabolic clock back to the prediabetes stage when a similar proportion of weight reduction has been achieved. This can be accomplished through reducing caloric intake and increasing physical activity. A simple rule of thumb is that if you just remove the equivalent of 1 bagel (300 calories) and add 2 miles of walking (200 calories) each day, you are on your way to losing 10 pounds over a 2-3 month period!

High Blood Pressure: Hypertension is defined as a systolic blood pressure (top number) of 140 mmHg and diastolic blood pressure (lower number) of 90 mmHg. The goal is to gradually lower blood pressure in older men and women. While an ideal blood pressure is less than 120/80, older men and women with long-standing hypertension typically have stiff blood vessels (arteries) and therefore lowering blood pressure too drastically and quickly (e.g., reducing systolic blood pressure from 160 mmHg down to 120 mmHg) may compromise blood flow to the brain and cause a stroke. Therefore the goal in older men and women is to more gradually lower blood pressure. This can be accomplished safely through dietary measures (less than the equivalent of 1/2 teaspoon of salt daily) and medication that is titrated over weeks to months (rather than hours to days).

High LDL Cholesterol: Lowering LDL (bad cholesterol) levels is an important component to reducing cardiovascular risk with benefits persisting well beyond age 65. A healthy LDL level is less than 100 mg/dL but if you have cardiovascular disease, your LDL target goal should be less than 70 mg/dL. Natural ways to lower LDL include foods that are high in soluble fiber (such as oats, beans and psyllium- see “Heal Your Heart” for a list of the Top 50 Foods) as well as safe and effective cholesterol lowering medications that are proven to reduce the risk of a heart attack and stroke.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland  and author of “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” published by Penguin Random House.

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