Supporting cardiovascular health is important at every age, and early influences can improve health outcomes years later
As the body ages, lots of changes happen that can increase a person’s risk for cardiovascular disease. Blood vessels narrow. Arteries stiffen. Cell mutations can occur, while genes can influence fate. Fortunately, researchers have found that there’s a lot people can do to reduce the negative effects of these changes — and it’s never too early or too late to start. In fact, the steps people take to support a healthy heart early in life can do wonders to support their cardiovascular function later on.
“We can control our destiny even if we can’t control the genes that we inherit,” said Daniel Levy, M.D., senior investigator of the Laboratory for Cardiovascular Epidemiology and Genomics at the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.
Researchers have long been studying how people can do that and have come up with multiple ways to predict how well a person’s cardiovascular system will function later in life. Many of these prediction models use standard measures of heart health, such as blood pressure and cholesterol levels. Additionally, researchers are studying how inflammation in the body may provide additional clues to predict heart health and perhaps lead to new treatments.
For all these advances, though, the overarching message remains the same: good lifestyle habits and attention to numbers can lead to stronger hearts and a longer, healthier life.
Looking closely at how to protect heart health
One way researchers have studied this is by quantifying the effects of eight criteria, called Life’s Essential 8 (LE8), that they use to assess cardiovascular health. The list includes four measurements — blood pressure, body weight, cholesterol, and blood sugar — and four lifestyle factors— including whether a person gets enough quality sleep, stays physically active, eats a heart-healthy diet, and avoids tobacco.
LE8 scores range from zero to 100. Higher scores, such as 80 or above, correlate with good health. Researchers have found that if a person increases their LE8 score by ten points, their cardiovascular disease risk could fall by about one-third. Having a higher LE8 score is also linked to having a younger biological age, a sign of how fast the body is aging on a cellular level.
“Cardiovascular health is at the center of healthy aging,” said Véronique L. Roger, M.D., M.P.H., senior investigator in the Laboratory of Heart Disease Phenomics at NHLBI. Many factors — including variables that affect where people live, work, and play — can shape cardiovascular health. This is why built environments and early-life influences are important, she explained.
Scientists have found, for example, that the early stages of atherosclerosis , the hardening of arteries, can start in childhood and go undetected for years, increasing risks for heart attack, heart failure, or stroke later in life.
Measuring cardiovascular risk early
To underscore just how important it is to reduce those kinds of risks, researchers are finding various ways to peer into the future. They’ve discovered that cumulative measurements of cardiovascular health can sometimes predict disease risks better than a single point in time. One study found that adults ages 45-60 whose blood pressure measured in the lower ranges over ten years had an associated reduced risk of developing cardiovascular disease 13 years later. If these adults did develop cardiovascular disease, they had a greater chance of delaying its onset and living about four years longer.
Scientists are not just focused on predicting the long-term impact of keeping blood pressure low, however. They are also studying how markers of inflammation circulating in the bloodstream, as well as indicators of cellular health, can further enhance predictions — not just for cardiovascular disease but for a range of age-related conditions. One model being studied is how to calculate a person’s ‘inflammatory age’ or iAge.
“The goal isn’t necessarily to stop the cardiovascular aging process,” said Nazish Sayed, M.D., Ph.D., an assistant professor in the Division of Vascular Surgery at Stanford University School of Medicine and the Stanford Cardiovascular Institute. “But what if we could make it more graceful, where there is less of a burden on the community and patient — and where we can predict it much earlier?”
Researchers in Sayed’s laboratory and at the Furman Laboratory at the Buck Institute for Research on Aging analyzed immune cells from more than 1,000 participants of all ages. They found certain characteristics — mainly elevated levels of the protein CXCL9, an inflammatory marker — were associated with a greater likelihood of disease, altered immune function, and advanced cardiovascular age.
“We all carry inflammation at some levels,” said Sayed. Everyday stress, lack of exercise, and poor diet can increase inflammatory molecules circulating in the bloodstream. Side effects from medications like chemotherapy or exposure to tiny air pollution particles, such as from wildfires, can contribute, too.
Increased CXCL9 levels are linked to reduced blood flow in the heart’s arteries, a hardening of blood vessels, and structural changes associated with heart failure. To test what happens if those levels are lower, Sayed’s team inhibited CXCL9 levels by silencing the gene responsible for their expression, and signs of cardiovascular inflammation fell.
Additional studies in larger populations are needed to translate these findings into practical measures people could take, including lifestyle changes or considering an anti-inflammatory medication or personalized therapies. The researchers believe these types of studies are moving the field closer to doing just that.
“With a few drops of blood, we can now analyze thousands of proteins,” said Levy, “and we’re using the knowledge gained to understand global patterns of inflammation.” At the same time, he added, researchers are gaining a greater understanding of the role that genes play in cardiovascular disease and other conditions, as well as factors that influence gene expression.
“Almost all of this is happening at breakneck speed,” he said, “that I predict in the near future, we will revolutionize our understanding of the molecular basis of human disease.”
For people looking for additional ways to support their heart health, he said, the benefits will be invaluable.
