The heart often pumps blood less efficiently in older people, usually because of insufficient physical activity. Poor heart conditioning allows fatty and connective tissues to infiltrate the heart’s muscular wall. However, this decline in cardiac output is not inevitable with aging and does not occur among older people who remain physically active. In fact, it is thought that the inactive lifestyles of nearly 60% of North American adults may contribute as much to the risk for cardiovascular disease as smoking a pack of cigarettes per day.
Heart attack and stroke, 2 of the 3 major causes of death in adults, are caused primarily by atherosclerosis and hypertension. As we age, atherosclerotic plaque accumulates in the arteries, reducing their elasticity, constricting blood flow, and consequently elevating blood pressure.
You already know the main way to limit the buildup of atherosclerotic plaque: Keep LDL-cholesterol and the total cholesterol/HDL-cholesterol ratio in the desirable range. New evidence shows that a diet very low in fat can cause some plaques to decrease in size. Other studies use diet and medications to lower blood cholesterol, which in urn reduces the amount of plaque in the arteries supplying the heart. This suggests that a heart-healthy diet is more important during middle to late adulthood than researchers previously thought. Consuming sufficient vitamin B-6, folate, and vitamin B-12 are also important to avoid elevated blood homocysteine, a probable risk factor for cardiovascular disease.
Much controversy surrounds the treatment for elevated LDL-cholesterol in people over the age of 70. If these people adhere to extremely restrictive diets limited in fat and energy to the point that they can’t keep up their weight, or if their diets lack variety, they may become undernourished. This may be a worse predicament for them than having high LDL-cholesterol. Therefore, treating elevated LDL-cholesterol in an older person who ahs other illnesses, such as chronic lung disease and dementia (which are likely to shorten life as well as hamper its quality) is probably inappropriate. However, if a healthy 70 year old who is likely to live another 10 to 15 years has both elevated LDL-cholesterol and evidence of cardiovascular disease, an eating and exercise plan is probably in order to reduce the chance of heart attack.
Hypertension is heavily implicated in both stroke and heart attack in older adults. Blood pressure can be lowered in many people by restricting salt intake. A limit of 2400mg of sodium per day helps many people with hypertension, but that is a difficult diet to plan and follow for older people who rely on convenience foods. Alternatively, a mild sodium restriction (not to exceed 4000mg of sodium daily) may be effective for salt-sensitive people but is not so helpful by itself for those who have hypertension that hypertension.
We can do much to prevent heart attack and stroke just by eating a balanced diet, walking briskly and otherwise performing regular physical activity, controlling blood pressure, not smoking, and maintaining healthy weight. Regular physical activity and a diet rich in fruits and vegetables are also associated with fewer strokes as adults age, as is a moderate use of alcohol.
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