Cardiovascular health declines in older adults with heart conditions

U.S. adults, ages 65 and older, with high blood pressure, heart failure or stroke had significant declines in cardiovascular health, according to new research published today in the Journal of the American Heart Association, an open-access, peer-reviewed journal of the American Heart Association.

The cardiovascular scores calculated in the analysis were based on participants' health data in relation to the American Heart Association's Life's Essential 8 health metrics for optimal cardiovascular health. Life's Essential 8 measures eight components for ideal heart and brain health - four health behaviors and four health factors, including: diet, physical activity, smoking status, sleep, body mass index, cholesterol, blood sugar and blood pressure.

During the COVID-19 pandemic, it became evident that older adults were disproportionately impacted by cardiovascular disease. We aimed to examine the state of cardiovascular health among older adults before the pandemic, establishing a baseline that would allow us to assess the changes that occurred during and after the pandemic."

James M. Walker, B.A., study co-author, fourth-year M.D./M.B.A. student at Northwestern University's Feinberg School of Medicine and Kellogg School of Management, Chicago

"This study provides new information about the cardiovascular health of older adults before the pandemic. It shows that overall heart health scores were getting worse, particularly for those with heart failure, stroke or high blood pressure," Walker said.

In this analysis of health information from the U.S. National Health and Nutrition Examination Survey from 2013 to 2018, researchers reviewed the changes in cardiovascular health, as measured by Life's Essential 8, among adults ages 65 and older. The analysis was based on a sample of 3,050 older adults, with survey weights applied to generate U.S. population-level estimates representing 37,908,305 adults ages 65 or older (54.7% women; average age of 72.6 years).

The analysis included adults with and without self-reported cardiovascular conditions, including coronary heart disease, stroke, heart failure, high blood pressure, heart-related chest pain, heart attack or no cardiovascular disease. Each Life's Essential 8 metric was scored for each person on a scale of 0 to 100 points (higher is better). Cardiovascular health was calculated for each person by summing the eight metric scores and dividing by eight. Scores below 50 indicate low cardiovascular health; 50 to 79 is considered moderate; and scores of 80 and above signal high cardiovascular health. The change in these scores from 2013 to 2018 was calculated for each group.

When the Life's Essential 8 scores among the groups were compared, the analysis found:

• People with no cardiovascular disease had an average cardiovascular health score of 68 out of 100.
• People who reported having one or more cardiovascular conditions had an average cardiovascular health score below 60, and scores tended to decline with each additional cardiovascular disease.
• From 2013-2018, cardiovascular health scores among people with high blood pressure decreased about 4.1% (from 59.6 to 57.1), 11.5% (from 60.6 to 53.6) among people with a history of stroke, and 15.2% (from 60.9 to 51.6) among people with heart failure.

"Physical activity and blood pressure scores tended to be very low for people with cardiovascular disease," Walker said. "On average, participants with one cardiovascular disease had a Life's Essential 8 score 9 points lower than those without cardiovascular disease. That gap seemed to be explained by low scores for blood pressure and physical activity."

"Health care professionals and physicians should seek to provide support earlier in life to help our elderly population stay healthier for longer," he said.

According to the researchers, these findings are intended to lay the groundwork for future research on how cardiovascular health trends may have changed in older U.S. adults with cardiovascular conditions.

"It's natural that as you age your health may start to decline, particularly as you develop conditions such as high blood pressure or have major cardiovascular events like a stroke. That's why the American Heart Association urges everyone to get their best start at good health by following the elements of Life's Essential 8 early in life, even as young as childhood," said Stacey E. Rosen, M.D., FAHA, volunteer president of the American Heart Association and senior vice president of women's health and executive director of the Katz Institute for Women's Health of Northwell Health in New York City. "It's also critical that we recognize that our aging population is quickly growing. The last of the Baby Boomers will reach 65 in the next 5 years, and more people are living longer, even after a heart attack or stroke, thanks, in part, to medical advances and improved diagnosis and treatment. We must identify ways to support these older individuals with information and resources to maintain a healthy lifestyle in every way they can, because good health is important at every age." Rosen was not a part of this study.

A main limitation of the study is that it is cross-sectional (analyzed different groups based on specific criteria), so it cannot prove cause and effect. Researchers also only examined six types of cardiovascular disease, so if participants had other cardiovascular disease (less common cardiovascular disease diagnoses), they may have been missed or not included in this analysis.

Study details, background and design:

• Researchers reviewed health data from the National Health and Nutrition Examination Survey (NHANES), 2013-2018, to examine the cardiovascular health of U.S. adults ages 65 and older. NHANES collects data about the health and nutrition of adults and children in communities across the U.S.
• The analysis included 3,050 adults (weighted to represent 37,908,305 adults; 54.7% women; average age of 72.6 years) with coronary heart disease, stroke, heart failure, high blood pressure, heart-related chest pain or heart attack, or no cardiovascular disease.
• Participants self-identified as 79.9% white, 7.2% Black, 3.4% Asian, 3.9% Mexican, 3.3% other Hispanic, and 2.4% selected other race, which included multiracial.