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Cardiovascular health appears to be suboptimal and in decline among older adults with high blood pressure, heart failure, or stroke compared with those without these conditions, according to new research published in the Journal of the American Heart Association.

Using data from the National Health and Nutrition Examination Survey from 2013 to 2018, researchers examined changes in cardiovascular health, as measured by the American Heart Association’s (AHA’s) Life’s Essential 8 (LE8), in adults aged 65 years or older with self-reported hypertension, stroke, heart failure, coronary heart disease, myocardial infarction, or angina.

LE8’s metrics include diet, physical activity, nicotine use, sleep health, BMI, blood pressure, blood lipids, and blood sugar, according to the study author Donald M. Lloyd-Jones, MD, ScM, from the Framingham Center for Population and Prevention Science at Boston University, Boston.

“LE8 scores have been studied in hundreds of populations across the globe, but most of these studies have focused on people who do not yet have [cardiovascular disease] CVD,” he said. “We examined current levels and trends of LE8 scores in older US adults who are living with CVD, and we [hypothesized] that LE8 would be a means for extending life and avoiding future cardiovascular events.”

Opportunities to Reduce Risk

Among 3050 older adults with and without CVD in the database, the researchers found the gap in cardiovascular health between people with and without CVD was primarily attributable to differences in blood pressure and physical activity.

When Lloyd-Jones’ group compared LE8 scores between the two groups, they found people with no CVD had an average cardiovascular health score of 68 out of 100. The average score for those with at least one cardiovascular condition fell below 60 and dropped further with each additional CVD.

Throughout the study period, LE8 scores decreased by 4.1% among people with hypertension, 11.5% among those with a history of stroke, and 15.2% among those with heart failure.

Nieca Goldberg, MD, clinical associate professor of medicine at NYU Grossman School of Medicine, New York City, and medical director of Atria New York City, said clinicians can help patients improve their odds of avoiding cardiovascular problems.

“This study highlights important information for [older adults] at high risk for cardiac events,” she said, noting that attaining blood pressure < 120/80 mm Hg is key. “Patients should be encouraged to take blood pressure measurements at home so that they can be engaged in their healthcare,” she said.

Goldberg suggested clinicians ask their patients who avoid physical activity what prevents them from exercising.

“Is it an orthopedic limitation such as knee and hip pain or back pain? In such a case, the patient may need physical therapy to increase their physical activity,” she said.

Goldberg also recommended that clinicians emphasize the importance of a low-salt diet that includes at least five servings of fruits and vegetables daily, lean proteins, and foods that contain calcium while avoiding processed foods, which tend to be high in salt and sugar.

Lloyd-Jones added that using the AHA’s online tool, MyLifeCheck, to measure LE8 can help quantify the cardiovascular health of older individuals with and without CVD and “present opportunities to improve health, prolong lifespan, and reduce the further burden of CVD.” “This can also help empower patients to control and improve modifiable aspects of their health,” he said.

Goldberg declared having no financial disclosures.

Martta Kelly is a medical journalist who lives in the New York metropolitan area.