Grow Younger, Live Longer
In a nutshell
- This article briefly overviews the mechanisms, symptoms, and possible treatments of the four most common cardiovascular age-related disorders, such as atherosclerosis, hypertension, heart attack, and stroke.
- Aging is a major risk factor for the development of these cardiovascular diseases. And although non-modifiable factors play a big role in developing these conditions, lifestyle choices can significantly lower this risk.
- We highlight scientifically proven lifestyle interventions that have been shown to have a protective role in developing these ailments.
Cardiovascular diseases are a group of disorders that affect the heart and blood vessels. According to WHO, cardiovascular diseases are the leading cause of death globally, accounting for more than 17.9 million deaths each year.
Among the four most common age-related cardiovascular diseases are atherosclerosis, hypertension (high blood pressure), myocardial infarction (heart attack), and stroke.
Atherosclerosis is a condition in which the arteries become narrowed and hardened due to plaque buildup. Plaque is a mixture of cholesterol, fat, and other substances that can accumulate on the inner walls of the arteries. Over time, this buildup can reduce or block blood flow to the organs and tissues, increasing the risk of heart attack, stroke, and other serious health problems. Atherosclerosis is the main risk factor for cardiovascular disease, which is the leading cause of mortality worldwide.
Main causes of Atherosclerosis
The fundamental underlying cause of atherosclerosis has not been fully understood, but its pathophysiology process is well established.1 Jebari-Benslaiman, Shifa et al. “Pathophysiology of Atherosclerosis.” International journal of molecular sciences vol. 23,6 3346. 20 Mar. 2022. PubMed Source Atherosclerosis is initiated by changes in the inner layer of the vessels, called the endothelium. The endothelium is located between circulating blood and the inner tissues of vessels, so it senses all changes in circulating blood. These changes include mechanical stress (depends on blood pressure) and concentration of metabolic factors in the blood (cholesterol, triglycerides, etc.).
After initial changes in the endothelium occur, plaques and other substances accumulate on the vessels’ inner wall, narrowing them. Plaques are usually comprised of cholesterol, fat, and calcium.
It is striking that atherosclerosis begins early in childhood2 McGill, H C Jr et al. “Origin of atherosclerosis in childhood and adolescence.” The American journal of clinical nutrition vol. 72,5 Suppl (2000): 1307S-1315S. PubMed Source and manifests clinically as coronary heart disease later in life.
Risk factors for Atherosclerosis
Some of the major risk factors for atherosclerosis include the following:3 Head, Trajen et al. “The Aging Risk and Atherosclerosis: A Fresh Look at Arterial Homeostasis.” Frontiers in genetics vol. 8 216. PubMed Source[7efn_note] 3 von Eckardstein, A. “Risk factors for atherosclerotic vascular disease.” Handbook of experimental pharmacology ,170 (2005): 71-105. PubMed Source
Age. It is considered that in men, the risk of atherosclerosis increases after age 45, while in women – after age 55.
A family history of early heart disease, such s myocardial infarction, or having a close relative with atherosclerosis can increase your risk.
High blood pressure is a major risk because it damages the walls of arteries, making it easier for plaque to build up.
High blood cholesterol and triglyceride levels. High levels of LDL (low-density lipoprotein) or triglycerides in the blood can contribute to the formation of plaque in the arteries. Also, elevated levels of apolipoprotein B (ApoB) have been found to increase the risk of developing atherosclerosis.4Behbodikhah, Jennifer et al. “Apolipoprotein B and Cardiovascular Disease: Biomarker and Potential Therapeutic Target.” Metabolites vol. 11,10 690. 8 Oct. 2021. PubMed Source
Metabolic disorders, like diabetes and obesity, can contribute to the development of high blood pressure, high cholesterol levels, all of which increase the risk of atherosclerosis.
Lifestyle factors include smoking, consuming high amounts of saturated fats in the diet, and a sedentary lifestyle.
Symptoms of Atherosclerosis
Most symptoms don’t show up until a blockage occurs following chest pain, shortness of breath, confusion, and loss of motor and sensory functions. That is why it is important to do a regular medical check-up with blood tests done.
Treatment of Atherosclerosis
Since atherosclerotic changes are already observed as early as childhood and adolescence, long-range prevention of atherosclerosis is the best way to decrease the risk of further cardiovascular diseases. This could be achieved by lifestyle habits or medications in people with high risk.
There are three classes of LDL cholesterol-lowering drugs (statins, ezetimibe, and PCSK9 inhibitors) widely used for the regression of atherosclerosis and reducing cardiovascular events in people with a high risk of atherosclerosis. Aspirin and blood pressure regulators are used as complementary treatments if needed.
Novel alternative treatments, like the usage of nanomedicines and theranostics for atherosclerosis, are under development.5 Zhang, Yicong et al. “Treatment of atherosclerotic plaque: perspectives on theranostics.” The Journal of pharmacy and pharmacology vol. 71,7 (2019): 1029-1043. PubMed Source Thi way of treatment uses nanoparticles to deliver drugs to the location of arterial plaque. It enables more efficient absorption of the drug by the body and aids in reducing plaque accumulation.
Potential protective factors and prevention of Atherosclerosis
There are several preventive and protective factors against atherosclerosis. These include:
- Healthy diet, in particular, the Mediterranean diet, rich in whole food and fish oil.
- Regular exercise, such as aerobic and muscle strength training.
- Physical activity can help improve cholesterol levels, reduce blood pressure, and maintain a healthy weight, all of which can lower the risk of atherosclerosis.
- Quitting smoking can significantly reduce the risk of atherosclerosis and other cardiovascular diseases.
- Healthy gut microbiome.
- Good stress management and good sleep.
- Clean environment: smoke/air pollutant-free
- Regular checkups with a healthcare provider can help identify and manage risk factors for atherosclerosis before they develop into more serious health problems.
Hypertension is essentially high blood pressure, which creates an elevated force of the blood pushing against the artery walls. Blood pressure is measured in millimeters of mercury (mm Hg). Normal blood pressure is usually less than 120/80 mm Hg, and pressure consistently above 140/90 mm is considered hypertension. 6 Hopkins Tanne, Janice. “US guidelines say blood pressure of 120/80 mm Hg is not “normal”.” BMJ (Clinical research ed.) vol. 326,7399 (2003): 1104. PubMed Source Keeping blood pressure within the range of 120/80 is crucial for preventing cardiovascular disorders.
Causes of hypertension
Hypertension is the result of many factors that cause blood pressure to rise and lead as a result to end-organ damage, including heart, brain, kidneys, and eyes. Genetics and lifestyle factors play a major role in developing high blood pressure. Among the lifestyle factors, the most important are a diet high in sodium, lack of physical activity, obesity, and excessive alcohol consumption.
Risk factors of hypertension
High blood pressure can be caused by various factors, including genetic, lifestyle, and environmental factors. Some of the most common risk factors for hypertension include:
- Age. The risk of hypertension increases as you age, especially at the age of over 65 years.
- Family history. If you have a family history of hypertension, you may be more likely to develop the condition.
- Ethnicity and race. Hypertension is more common in African, Hispanic, and Native Americans.
- Chronic conditions, such as kidney disease, adrenal and thyroid disorders, sleep apnea, and obesity.
- Taking birth control pills with estrogen.
- Lifestyle factors: smoking, being overweight, sedentary lifestyle, too much salt in the diet, too much alcohol consumption, too little potassium, calcium or magnesium in the diet, poor stress management.
Symptoms of hypertension
High blood pressure is often called the “silent killer” because it usually has no symptoms. The only way to know about it is to measure it at home or at a health care center by doing regular medical checkups.
If your blood pressure is extremely high, there may be certain symptoms, such as severe headaches, nosebleeds, fatigue or confusion, vision problems, chest pain, and difficulty breathing.
Treatment of hypertension
Simple lifestyle changes can help reduce high blood pressure. However, some people may also need to take medicine if their blood pressure is constantly higher than 140/90mmHg.
Lifestyle changes include cutting salt consumption (below 6g/day), eating a low-fat, healthy diet with fruits and vegetables, reducing/eliminating alcohol and caffeine, getting a healthy BMI, and regular exercise.
Common medications include angiotensin-converting enzyme (ACE) inhibitors or angiotensin-2 receptor blockers (ARB) for people under 55 years old and calcium channel blockers (CCB) for people over 55 years old. Also, diuretics can be effective in reducing blood pressure and used as a complementary treatment. Most people need two or more classes of blood pressure medications to reach the target.
Potential Protective Factors and Prevention of Hypertension
Regular exercise, healthy diet (DASH plan), healthy weight, limiting alcohol, no tobacco, sufficient sleep, good stress management, and regular checkups.
3. Myocardial infarction (or heart attack)
Myocardial infarction (or heart attack) is a serious medical condition in which the blood supply to the heart is blocked, leading to damage to the heart muscle. This can be caused by a blockage in one or more of the coronary arteries, which supply blood to the heart. Heart attacks can be life-threatening and require immediate medical attention.
Causes of Heart Attack
The actual cause of a heart attack is a blood clot that blocks the blood supply to the heart muscle leading to oxygen starvation. Heart muscle cells start to suffer damage and die, with irreversible damage happening already after 30 minutes of blockage. Blood clots are formed from plaque buildup in the arteries (atherosclerosis).
Risk Factors for Heart Attack
There are several risk factors that can increase the chances of having a heart attack. Some of the most common risk factors include:
- Age. The risk of heart attack increases with age, especially for men over 45 and women over 55.
- Gender. Before the age of 55, men are more likely to have a heart attack than women, but women’s risk increases after menopause.
- Family history. If a close family member has had a heart attack, your risk is higher.
- Genetic factors. Variations in some genes may predispose to a higher risk of having a heart attack.
- Medical conditions, such as diabetes, high blood pressure, high blood cholesterol and triglyceride levels, obstructive sleep apnea
- Lifestyle factors, such as smoking, poor stress management, being overweight, a sedentary lifestyle, too much alcohol, a diet high in saturated fat
Symptoms of Heart Attack
Symptoms do not appear until a blockage happens. Initial symptoms include sudden chest pain or discomfort, shortness of breath, pain or discomfort in the jaw, neck, back, arm, or shoulder, cold sweat, and nausea. Sometimes myocardial infarctions can happen without any symptoms at all, they are called “silent” heart attacks. They are discovered later on in electrocardiograms.
Treatment of Heart Attack
The treatment for a heart attack will depend on the severity of the attack and the specific needs of the individual patient. Some medications include aspirin, clopidogrel, heparin, or other anticlotting agents to prevent new clots, thrombolytic drugs to dissolve existing clots, nitroglycerin to widen coronary vessels, anxiolytics to help with anxiety and pain.
Then the healthcare provider will assess the necessity for coronary artery procedures to open up the blocked coronary artery, such as angioplasty (when a catheter is guided into the blocked artery to open it up, and then a stent is inserted to keep the artery open), atherectomy (when blade or laser is used in combination with a catheter to clear out plaque build-up), or coronary artery bypass surgery (when surgeons create new routes through which blood can flow around blocked or narrowed arteries).
Follow-up treatment usually includes lifestyle changes recommendations and medications (aspirin, beta-blockers, calcium channel blockers, or angiotensin-converting enzyme (ACE) inhibitors to control high blood pressure, statins (to reduce cholesterol), anti-diabetic medications (to control blood sugar), nitrates (to improve blood flow and reduce angina).
Potential Protective Factors and Prevention of Heart Attack
Some lifestyle interventions and medications have been shown to reduce the risk of a heart attack. These interventions include regular aerobic physical activity, a diet low in fat, cholesterol, and salt, regular checkups, quitting smoking, maintaining a healthy weight, and low doses of aspirin.
Stroke is a serious medical condition that occurs when the blood supply to the brain is interrupted or reduced. A stroke is a life-threatening condition and requires immediate medical attention.
Causes of Stroke
There are two main reasons for stroke: blocked blood vessels leading to the brain (ischemic stroke) or bleeding in or around the brain (hemorrhagic stroke).7 Amarenco, P et al. “Classification of stroke subtypes.” Cerebrovascular diseases (Basel, Switzerland) vol. 27,5 (2009): 493-501. PubMed Source
Ischaemic strokes are the most common type of stroke. They happen when a blood clot blocks the flow of blood and oxygen to the brain and are usually the result of atherosclerosis. Another possible cause of ischaemic stroke is a type of irregular heartbeat called atrial fibrillation. In this case, an irregular heart rhythm can cause blood to collect in the heart’s upper chambers and form clots. If this blood clot breaks free from the heart area, it can travel to the brain and cause a stroke.
Hemorrhagic strokes are less common than ischaemic strokes. They happen when a blood vessel inside the skull bursts and bleeds into and around the brain. The main cause of hemorrhagic stroke is high blood pressure, which can weaken the arteries in the brain and make them more likely to split or rupture. Another reason for hemorrhagic stroke is an aneurysm (a weak or thin spot in a blood vessel that bulges or bursts).
Risk Factors for Stroke
Some of the most common risk factors for stroke include:
- Age. It is more common to occur after age of 55.
- Genetic factors
- Family history of stroke.
- Race and ethnicity. Asian, African, or Caribbean are at higher risk)
- Previous medical history. Any of the following conditions increase the risk of stroke: previous incidents of stroke, heart attack, transient ischaemic attack, high blood pressure, high blood cholesterol, obstructive sleep apnea.
- Taking some oral contraceptives and hormone replacement therapy.
- Lifestyle factors, such as being overweight, too much alcohol, smoking, poor stress management, sedentary lifestyle.
Symptoms of stroke
The symptoms of stroke can vary depending on the type of stroke and the area of the brain affected. However, they are usually sudden and include weakness or numbness in the face, arm, or leg, especially on one side of the body, difficulty speaking or understanding speech, vision problems in one or both eyes, dizziness, loss of balance, or difficulty walking, severe headache with no known cause.
Treatment of Stroke
Treating a stroke depends on many different factors, and firstly on its type, ischemic or hemorrhagic.
Treatment of ischemic stroke
Treatment options for ischemic stroke may include medications to break up the blood clot (thrombolytics) and restore blood flow to the brain, as well as procedures to remove the clot (thrombectomy) or bypass it. If the blood circulation is restored quickly enough, it might be possible to prevent permanent damage or at least limit a stroke’s severity.
Treatment of hemorrhagic stroke
With hemorrhagic strokes, treatment depends on the location and severity of the bleeding but the priority is always to reduce blood pressure. This will reduce the amount of bleeding and keep it from getting worse. Also, the medications for improving blood clotting can be given together with surgeries aimed to repair the damaged blood vessel or remove the blood that has accumulated in the brain.
Treatment for stroke always includes rehabilitation to help the person recover their strength, mobility, and independence. Rehabilitation may include physical therapy, occupational therapy, and speech therapy, among other types of therapy.
Potential protective factors and Prevention of Stroke
There are several potential protective factors and prevention measures that can help reduce the risk of stroke. These include maintaining healthy blood pressure and healthy weight, quitting smoking, limiting alcohol consumption, eating a healthy diet low in salt, fat and sugar and rich in fiber, and regular exercise.
Recap and final thoughts
Cardiovascular diseases are a leading cause of mortality worldwide. While such conditions can manifest at a young age, the risk of developing them increases considerably with age. This group of ailments comprises atherosclerosis, hypertension, heart attack, and stroke.
While a genetic or familial predisposition to cardiovascular diseases exists, they are preventable and can be mitigated through basic lifestyle interventions. Examples of such interventions include engaging in regular exercise, consuming a healthy diet (such as the Mediterranean diet, which emphasizes whole foods and fish oil while limiting salt), quitting smoking and alcohol consumption, and managing stress effectively.
- 1Jebari-Benslaiman, Shifa et al. “Pathophysiology of Atherosclerosis.” International journal of molecular sciences vol. 23,6 3346. 20 Mar. 2022. PubMed Source
- 2McGill, H C Jr et al. “Origin of atherosclerosis in childhood and adolescence.” The American journal of clinical nutrition vol. 72,5 Suppl (2000): 1307S-1315S. PubMed Source
- 3Head, Trajen et al. “The Aging Risk and Atherosclerosis: A Fresh Look at Arterial Homeostasis.” Frontiers in genetics vol. 8 216. PubMed Source[7efn_note] 3 von Eckardstein, A. “Risk factors for atherosclerotic vascular disease.” Handbook of experimental pharmacology ,170 (2005): 71-105. PubMed Source
- 4Behbodikhah, Jennifer et al. “Apolipoprotein B and Cardiovascular Disease: Biomarker and Potential Therapeutic Target.” Metabolites vol. 11,10 690. 8 Oct. 2021. PubMed Source
- 5Zhang, Yicong et al. “Treatment of atherosclerotic plaque: perspectives on theranostics.” The Journal of pharmacy and pharmacology vol. 71,7 (2019): 1029-1043. PubMed Source
- 6Hopkins Tanne, Janice. “US guidelines say blood pressure of 120/80 mm Hg is not “normal”.” BMJ (Clinical research ed.) vol. 326,7399 (2003): 1104. PubMed Source
- 7Amarenco, P et al. “Classification of stroke subtypes.” Cerebrovascular diseases (Basel, Switzerland) vol. 27,5 (2009): 493-501. PubMed Source