New therapies for keeping hearts healthy
Written by Norma Rabago
While aging itself increases the risk for developing cardiovascular disease, much can be done to prevent hypertension and reduce the odds of stroke or heart failure.
Open heart surgery is currently the only treatment for older adults with tricuspid valve disease. That can be changed, according to Allen Anderson, MD, FACC, FAHA, chief of the Division of Cardiology at the Long School of Medicine at UT Health Science Center San Antonio.
Anderson is investigating new, less-invasive therapies for tricuspid valve disease, a type of heart valve disease characterized by a leaky valve between the right ventricle and right atrium. When this valve doesn’t work properly, the heart works harder to pump blood into the lungs and to the rest of the body. Severe leakage of this valve can lead to heart failure and kidney dysfunction if left untreated.
Anderson is part of a national team studying catheter-based therapies that can repair the leaking tricuspid valve without surgery. This would open treatment of damaged tricuspid valves to many more patients.
“Catheter-based therapies are sometimes the best option because the risks of open-heart surgery are very high or, in some instances, the patient is too sick or frail to undergo open heart surgery,” Anderson said. “Not all valve disease has a catheter-based approach. New technologies are under development, and we will study the types of valve disease that can be treated less invasively.”
The high stakes of high blood pressure
Heart failure is the leading cause of hospitalization in those 65 and older, said Anderson.
“As the human organism ages, repair mechanisms don’t work as well,” he said. “Aging is associated with an increased risk for coronary artery disease and stroke.”
Anderson’s team is working to decrease the mortality from heart disease, which is the No. 1 killer of adults in Texas and often comes from common problems left untreated. One common cause of heart disease is poorly treated hypertension, said Anderson.
By age 60, about 60% of the population will have hypertension. By age 70, 65% of men and 75% of women will have developed hypertension.
“While it becomes more common with aging, hypertension is a disease that often starts in the third or fourth decade of life,” Anderson said. “Left untreated, the complications of hypertension manifest in the 50s and beyond. Arterial wall stiffness, an adverse effect associated with aging, can lead to the development of hypertension.”
In most patients, Anderson said, the cause of hypertension is unknown. For some, an unlucky roll of the genetics dice could be a cause. However, a diet high in salt, often associated with an American diet, obesity and sleep apnea are contributing factors to the development of the disease.
“Hypertension is both a problem of dysfunctional blood vessels and the result of damage to these vessels,” said Anderson. “Particular areas are prone to damage from hypertension, such as the kidney, brain and aorta. The damage to kidneys and brain can be severe and lead to renal failure and stroke.”
Leaving hypertension untreated not only impacts blood vessels, but also the brain, eventually leading to vascular dementia, said Anderson.
“Vascular dementia refers to the brain-damaging effects of hypertension on the brain circulation leading to small hemorrhage and impaired blood flow to parts of the brain,” he said. Treatment of hypertension can lessen the likelihood of these vascular complications.
Hypertension prevention
According to Anderson, the single worst thing an individual can do to damage their blood vessels, other than not treating hypertension, is to smoke.
“The lining of the blood vessels, called the endothelium, is affected, as are the deeper layers of the arteries,” he said. “The result of damaging the blood vessel lining is the increased deposition of cholesterol, accelerating the process of atherosclerosis. This occurs in many vascular beds including the brain, the heart and the peripheral arteries to the arms, legs and organs.”
So, the first thing any hypertension patient needs to do to treat their high blood pressure is to quit smoking. Sometimes, that alone is all that is needed.
While coronary artery disease is a progressive disease that starts in young adulthood, for the aging population, it can become a clinically important problem causing coronary insufficiency or heart attack, Anderson said.
On the bright side, maintaining a healthy heart during aging is achievable. Some damage is even reversible, Anderson said. One way to reverse hypertension and heart damage is aerobic exercise, such as walking, running, swimming, biking or use of equipment like an elliptical, treadmill or stationary bike after consulting with a physician about the appropriate intensity. Aerobic exercise may be easier if a person joins a group to which they are accountable. This can provide extra motivation for maintaining an exercise schedule.
Another key to promoting a healthy heart by aerobic exercise is to realize that distance matters as much as speed. It is not how fast a person goes, but how far. Many individuals try to go too fast at first, then become discouraged when they are too exhausted to continue. A slower speed for a longer distance burns the same calories and is much easier to complete. A good exercise rate is not more than two-thirds of a person’s maximum heart rate, which is 220 minus their age.
Of course, exercise does little good if a high-fat, high-salt diet is maintained at the same time. The good news is that exercise can suppress appetite.
Perhaps the single best intervention anyone can do to promote healthy aging is to regularly check their blood pressure and then comply with treatment if it is high.
The earlier a person begins to maintain a healthy heart the better, but it is never too late, Anderson said. The benefits of any of these positive actions begin to accrue almost immediately.
