Better Cardiovascular Outcomes Start with Better Childhood Habits

Norrina Allen, PhD

The best way to promote healthier aging might be by promoting better cardiovascular health throughout life.

During the American Heart Association (AHA) 2019 Scientific Sessions in Philadelphia, Norrina Allen, PhD, associate professor of preventive medicine and pediatrics, Feinberg School of Medicine Northwestern University, explained that along with reductions in mortality and cardiovascular disease, cardiovascular health is related to a wide range of important outcomes including quality of life, a reduction in depression, healthcare charges, and cognition.

“Unfortunately, in this population we see a significant decline in cardiovascular health with age, so that even in the teens only 50% of teenagers are an ideal cardiovascular health and that declines to less than 10% in individuals who are 60 and older,” Allen said.

In 2010 AHA defined and set strategic goals around a cardiovascular health metric that included multiple health behaviors such as smoking, diet, physical activity, body weight, and health factors like glucose, cholesterol, and blood pressure.

According to Allen, there is an increasing amount of literature showing that cardiovascular health risk factors is related to long-term outcomes.

She cited a study that evaluated patients’ cardiovascular health around age 45 by following them through Medicare claims until they passed away.

“What we saw was that among individuals who came into Medicare at about 65, free of cardiovascular morbidity, as they aged the group of individuals had all favorable levels of those cardiovascular factors, had significantly lower morbidity scores at every year of age, as compared to the people who had 2 or more elevated risk factors,” Allen said. “So, they had significantly higher comorbidities and those increased more steeply with age.”

Allen said one of her research focuses is looking at health span as opposed to a lifespan. This is a way to evaluate how a patient’s quality of life is going to change as they age in regard to health.

“We found that individuals who had 2 or more high risk factors, lived on an average, to the age of 76 before they had the occurrence of a cardiovascular morbidity, and then they live with morbidity until they passed away at an average age of 84,” Allen said. “And so, they lived about 8-years, with increasing levels of comorbidities or about 43% of their older age.”

On the other hand, individuals who had favorable levels on all of the major risk factors lived on average to the age of 83 before they had any onset of morbid cardiovascular conditions, increasing their health span and compressing the amount of life spent with morbidity to about 5 years or less.

“This is some of the reasons why we argue that increasing the prevalence of cardiovascular health is going to translate into improvements in successfully aging population,” Allen said.

In recent years researchers have been able to better define what successful aging entails outside of an absence of disease and avoiding smaller morbid conditions.

“It's also about maintaining high cognitive function and maintaining involvement or engagement with life and physical function,” she said, adding that a previous multi-ethnic study of atherosclerosis showed that only about 18% of the study population successfully achieved this criterion.

Compared to individuals who start off middle age in poor cardiovascular health, those that are an intermediate or ideal to the major risk factors are about 2.5 times more likely to be aged successfully by 75-years old, which takes into account all other aspects in terms of education, marital status, income, or alcohol consumption.

To improve these cardiovascular outcomes and promote healthier aging, Allen said the first step will be to start early because the origins of heart disease and many other age-related diseases begin in childhood and increase throughout life.

Allen also said that preservation has proven to be more effective at improving outcomes than trying to teach people to undo bad habits to regain healthier lifestyles.

Another priority to promote healthier aging is intervention at multiple levels, including through family, community, and society as a whole.

“There are abilities to intervene at the individual family community level, as well as policy level, and I think we need a successful a successful strategy will intervene in all of those different contexts,” Allen said.

The third critical point is tailoring all of the interventions to the settings and to the culture to make them relevant and more effective.

The final point is cost effectiveness and sustainability.

“We know that if we bring people into a clinic, and we force them to eat what we want and we make them exercise, they will often lose weight,” Allen said. “The problem is, then they go back into society and they can't maintain that level of stringency.”