Obesity, unhealthy lifestyles may cause heart to age by 5–45 years
The key to early intervention for cardiac problems may lie in determining the heart's 'true' age, new research suggests. Sven Braun/picture alliance via Getty Images Tracking and evaluating cardiac health are critical to catching heart problems early and finding helpful interventions.
One study found that cardiac magnetic resonance imaging (MRI) may help determine the heart's functional age compared to biological age.
The findings showed that unhealthy lifestyles, as well as some chronic conditions such as obesity and atrial fibrillation (AFib), made the heart age faster.
The methods described in this study could help with early intervention before major heart concerns develop.
Evaluating how well the heart is doing and what changes have occurred can help doctors and people make informed decisions about heart health.
To do that, a recent study examined a way to calculate the functional age of people's hearts compared to their biological age.
The study used a model based on cardiac magnetic resonance imaging (MRI), and found that certain health conditions, such as obesity and AFib, and leading an unhealthy lifestyle, can increase the functional age of the heart.
People with certain conditions can also experience distinct heart changes that differ from healthy heart aging.
The findings were published in the European Heart Journal Open.
Researchers of this retrospective observational study wanted to explore a way to measure the age of people's hearts and what happens in healthy versus unhealthy aging. They note that certain modifiable risk factors, like high blood pressure, can speed up how fast the heart ages. One potential tool to look at how the heart looks and functions is cardiac magnetic resonance imaging.
Researchers used a healthy reference population of 191 participants and compared them to a testing population of 366 participants who had at least one comorbidity, such as high blood pressure, diabetes, or obesity. Researchers also used another group of 25 people as a 'preliminary external validation' cohort.
Participants were from five different locations across three countries. Researchers were able to look at several components of heart structure and function. They then developed a model to help determine the age of participants' hearts and also did statistical analyses.
There were distinct heart differences between the healthy and unhealthy groups. For example, the unhealthy group had a higher median stroke volume , which involves how much blood the left ventricle is pumping out when it contracts.
The final model researchers used considered left atrial end-systolic volume and left atrial ejection fraction, which both evaluate the function of the left upper chamber of the heart. These two factors were functional parameters significantly related to age among 169 healthy participants.
Researchers found that healthy participants' heart ages were about the same as how old they were. Unhealthy participants saw heart ages higher than their chronological age. The cardiac magnetic resonance-derived heart ages were almost five years older than the chronological age of these participants.
Obesity appeared to increase functional heart age, with more weight increasing heart years. Participants with a body mass index of 40 or higher had a functional heart age 45 years higher than their chronological age. For participants with atrial fibrillation, heart functional age was also higher than it was for healthy participants.
Functional heart age was sometimes higher for other comorbidities in certain age groups. In participants between the ages of 30 and 69, participants with high blood pressure had increased functional heart age compared to healthy participants who were in the same age category.
Similarly, diabetes increased functional heart age for participants between 30 and 69, with the greatest increase seen in the 40 to 49-year-old group. But in the seventy to 85-year-old group, participants with diabetes and high blood pressure actually had lower functional heart ages than healthy participants of the same age.
Speaking to MNT , study author Pankaj Garg, MD, PhD, Associate Professor in Cardiovascular Medicine, University of East Anglia, Norwich, UK, highlighted a few key findings. A heart that's 5 to 45 years older
'We have discovered an equation—a simple math formula—that uses movies from heart MRI scans to figure out how old your heart looks. For healthy folks, their heart age matches their real age. But if someone has [conditions] like high blood pressure, diabetes, a wonky heartbeat, or extra weight, their heart can look way older—about 4.6 years older on average. For people with a lot of extra weight, their hearts looked up to 45 years older!'
— Pankaj Garg, MD, PhD
This research is a great possible step towards more effective cardiac health monitoring, but it also has limitations. First, this work involved estimations and estimated the functional age of the heart. Second, since the study was not long-term, there's a higher risk for survivor bias. This could then minimize how comorbidities truly affect older people. Thirdly, researchers did not measure how long participants had had the measured comorbidities. So, it's possible that there was variety among unhealthy participants regarding how long they had comorbidity exposure. Bias is noted in some of the calculations. Researchers also noted the possibility of selection bias. This study did not assess certain factors like exercise and diet.
Researchers also acknowledge that there could have been variation in the unhealthy group because of medical treatments.
Researchers had certain exclusion and inclusion criteria in place, which impacted who they could include in the study. For example, they excluded people with severe chronic kidney disease, which is a contraindication for the MRI scans they used. Development of the age calculation model involved making a number of decisions, and researchers may find areas for refinement.
Patrick Kee, MD, PhD, a cardiologist at Vital Heart & Vein who was not involved in the study, noted several potential limitations of the study, including its inability to examine long-term data, lack of other measurements that could have been helpful, and use of a simple model that focused on left atrium end-diastolic volume and left atrium ejection fraction.
Long-term studies will likely be beneficial, as well as seeing how changing factors like lifestyle could help alter outcomes.
'The model was preliminarily validated on a small cohort, necessitating larger-scale validation to confirm its reliability and robustness for clinical application. Furthermore, it remains unclear whether lifestyle and therapeutic interventions will alter the trajectory of the heart age due to underlying medical conditions,' Kee noted.
Cheng-Han Chen, MD, a board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, who was also not involved in the study, noted that determining the functional age of the heart could be a helpful preventive measure.
'An assessment of a 'functional heart age' (either through imaging or other biomarkers) can potentially motivate patients to improve their lifestyles, identify patients at risk for future clinical events, and possibly even evaluate response to clinical therapeutics and interventions.'
— Cheng-Han Chen, MD
Using cardiac MRI also has an appeal because of the ease of use.
'Heart MRI scans are completely noninvasive tests—meaning no cuts or needles—and for checking the heart age, only a few minutes of this test are required. If necessary, this can be done in a focused way to help lots of people quickly. That might help catch heart trouble early and stop bigger problems, like heart failure, later on,' Garg explained to MNT .
Finally, there could also be improved communication between doctors and people at risk for heart problems. As the authors in the study noted, it could help people see the need to make changes. Chronological vs. functional age
'By comparing a patient's 'functioning heart age' with their 'chronological age,' clinicians can effectively communicate 'cardiovascular risk' to encourage lifestyle and therapeutic modifications. This approach can also serve as a tangible measure to motivate patients toward preventive strategies such as weight management, blood pressure control, and diabetes management to mitigate the progressive decline in heart health. Tracking changes over time allows clinicians to adjust treatment plans before irreversible damage occurs.'
— Patrick Kee, MD, PhD
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