Avoiding heart disease risk factors can improve vascular ageing 10-fold

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FOCUSVascularOlder adults who avoided at least six out of seven risk factors for heart disease – high blood pressure, elevated cholesterol, high blood sugar, inactivity, poor diet, obesity and smoking – were 10-fold more likely to be able to maintain the blood vessels of a healthy person under 30-years of age, well into old age. The large data analysis is from the Framingham Study, covering just under 10 years.

Some people who avoid risk factors for heart disease like obesity and diabetes may be able to maintain the blood vessels of a healthy 29-year-old well into old age, Reuters Health reports a US study suggests.

Researchers examined data on 3,196 adults age 50 and older to see how their odds of what’s known as vascular ageing – reduced elasticity in blood vessels – was influenced by seven risk factors for heart disease: high blood pressure, elevated cholesterol, high blood sugar, inactivity, poor diet, obesity and smoking.

Older adults who avoided at least six of these problems were 10 times more likely to have flexible, properly functioning blood vessels than their peers who managed to avoid no more than one of these risk factors, the study found.

“Especially staying lean and avoiding diabetes seemed to be very important,” lead study author Teemu Niiranen of Boston University School of Medicine said. “This association is thought to be mainly caused by the excess inflammation and neuro-hormonal imbalances associated with obesity and diabetes.”

In young, healthy people arteries are like soft rubber tubes that easily absorb the shock each time the heart muscle contracts and ejects blood into the vessels. But with age, the artery walls usually get thicker and lose elasticity, eventually leading to high blood pressure as they become less shock absorbent.

None of the participants had cardiovascular disease when they joined the study, but after researchers followed half of them for at least 9.6 years, 391 people developed the heart disease including 207 events like heart attacks. People with healthy arteries were about 55% less likely to develop heart disease compared to the rest.

Overall, 566 participants, or almost 18%, had healthy vascular ageing. This included about 30% of people in their 50s, and 7% of individuals in their 60s but just 1% of people 70 and older.

In addition to avoiding diabetes and obesity, maintaining healthy cholesterol levels was also a main contributor to healthy vascular ageing, researchers report.

Some other risk factors for heart disease, including smoking, diet and exercise, weren’t independently associated with healthy vascular ageing.

The study isn’t a controlled experiment designed to prove how individual risk factors for heart disease directly influence vascular aging. Limitations of the study include the predominantly white participants, which may mean the results don’t apply to other racial and ethnic groups, the authors note. Researchers also lacked complete data on nutrition and physical activity for all of the participants.

Still, the findings suggest the combined effect of many lifestyle decisions may be able to help some people maintain healthy arteries even with advanced age, the authors conclude.

Increased vascular stiffness, however, is just one aspect of the progression of cardiovascular disease, noted Dr Christian Delles of the Institute of Cardiovascular and Medical Sciences at the University of Glasgow in the UK.

Other aspects, such as narrowing of the vessels in certain places or the presence of plaque can’t be assessed by tests of vascular stiffness, Delles, who co-authored an editorial accompanying the study, said. But patients who still have healthy arteries may take the study finding as a road map to try to maintain that health as they age, Delles added.

“Controlling risk factors can keep your arteries healthy and it is worth addressing the well-known risk factors,” Delles said. “This includes lifestyle measure such as weight reduction, physical exercise and smoking cessation but in most cases also medication such as blood pressure lowering drugs and lipid lowering drugs.”

Hypertension and increased vascular stiffness are viewed as inevitable parts of ageing. To elucidate whether the age-related decrease in vascular function is avoidable, we assessed the prevalence, correlates, and prognosis of healthy vascular ageing (HVA) in 3196 Framingham Study participants aged ≥50 years. We defined HVA as absence of hypertension and pulse wave velocity <7.6 m/s (mean+2 SD of a reference sample aged <30 years). Overall, 566 (17.7%) individuals had HVA, with prevalence decreasing from 30.3% in people aged 50 to 59 to 1% in those aged ≥70 years. In regression models adjusted for physical activity, caloric intake, and traditional cardiovascular disease (CVD) risk factors, we observed that lower age, female sex, lower body mass index, use of lipid-lowering drugs, and absence of diabetes mellitus were cross-sectionally associated with HVA (P<0.001 for all). A unit increase in a cardiovascular health score (Life’s Simple 7) was associated with 1.55-fold (95% confidence interval, 1.38–1.74) age- and sex-adjusted odds of HVA. During a follow-up of 9.6 years, 391 CVD events occurred. In Cox regression models adjusted for traditional CVD risk factors, including blood pressure, HVA was associated with a hazard ratio of 0.45 (95% confidence interval, 0.26–0.77) for CVD relative to absence of HVA. Although HVA is achievable in individuals acculturated to a Western lifestyle, maintaining normal vascular function beyond 70 years of age is challenging. Although our data are observational, our findings support prevention strategies targeting modifiable factors and behaviors and obesity, in particular, to prevent or delay vascular aging and the associated risk of CVD.

Teemu J Niiranen, Asya Lyass, Martin G Larson, Naomi M Hamburg, Emelia J Benjamin, Gary F Mitchell, Ramachandran S Vasan

Reuters Health report
Hypertension abstract
Hypertension editorial

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