Nine elements to protect the cardiovascular health of the elderly!

Author: Kong Chan, deputy chief nurse of Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology

Sun Jingyao Doctor of Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology

Wang Mei Deputy Chief Nurse, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology

Reviewer: Ruan Lei, deputy chief physician of Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology

In 2022, the American Heart Association released the "Eight Elements of Life" to evaluate and guide the maintenance of cardiovascular health, introducing the ideal evaluation criteria for eight elements: diet, exercise, sleep, smoking, obesity, blood sugar, blood lipids, and blood pressure. In 2024, scholars from Yale University in the United States published an article in Circulation, a top journal in the cardiovascular field, proposing the "Nine Key Elements of Life", which added "mental health" to the above eight elements. Studies have found that if a person's nine elements can reach an ideal state, half of cardiovascular diseases can be prevented, the risk of death from cardiovascular diseases can be reduced by 50%, and the aging process of the body can be slowed down.

The implementation of the above elements is more specific and targeted for the elderly because they are facing aging, comorbidities, multiple geriatric syndromes and more fragile psychological conditions. Therefore, we will introduce specific methods for the elderly to achieve the ideal state of these 9 elements from the perspective of geriatric medicine, and guide everyone to improve cardiovascular health safely.

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1. The ideal state of the “9 key elements of life”

1. Balanced diet Based on the Mediterranean diet pattern, dietary status can be measured by assessing the intake of the following 16 food categories.

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2. Regular exercise: At least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week.

3. Do not smoke: including traditional cigarettes and e-cigarettes, and avoid inhaling secondhand smoke.

4. Healthy sleep: Ensure 7 to 9 hours of sleep every day.

5. Maintain a healthy weight: body mass index <25 (kg/m2), body mass index = weight (kg) / height squared (m2).

6. Ideal blood lipids: non-HDL cholesterol < 3.4mmol/L. Non-HDL cholesterol = total cholesterol - HDL cholesterol.

7. Ideal blood sugar: fasting blood sugar <5.6mmol/L (or glycosylated hemoglobin <5.7%).

8. Ideal blood pressure: blood pressure <120/80 mmHg.

9. Mental health: You can conduct a quick screening by using the following 4 questions. If the total score is less than 3 points, it indicates that the mental state is healthy.

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2. How should the elderly safely optimize the “9 key elements of life”?

For the above 9 elements, the closer they are to the ideal state, the healthier the cardiovascular system will be. However, as a special and vulnerable group, if the elderly blindly pursue the ideal state, it may cause harm to the body. By reviewing relevant guidelines and expert consensus at home and abroad, we have sorted out safe ways for the elderly to optimize these 9 elements.

1. Diet: The elderly usually have problems such as poor diet quality and malnutrition. Therefore, the diet of the elderly should emphasize quality, and protein intake should be prioritized. The elderly can improve their diet quality through the following two diet patterns.

(1) Mediterranean diet: It advocates the intake of more vegetables, fruits, whole grains, beans, nuts, olive oil, fish and seafood, moderate intake of poultry, eggs, cheese and yogurt, and less consumption of sweets and red meat.

(2) DASH diet: The full name of this diet pattern is “Dietary Approaches to Stop Hypertension”. The DASH diet advocates the intake of more fruits, vegetables, whole grain products, low-fat dairy products and lean protein, while also recommending a reduction in the intake of fat, sweets, red meat and sugary drinks.

The following are recommended foods rich in high-quality protein.

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2. Exercise: The elderly often sit for long periods of time, and lack of physical activity can lead to skeletal muscle loss, weakness and metabolic syndrome. For the elderly, it may be difficult or risky to perform 150 minutes of moderate-intensity exercise or 75 minutes of high-intensity exercise per week. The main purpose of exercise for the elderly is to avoid physical inactivity. As long as they can move, it is beneficial to health even if the duration and intensity do not meet the ideal standards. The elderly can determine the most suitable type of exercise and duration of exercise under the guidance of a doctor based on their personal preferences, functional status, cognitive status, motor skills and risk of falls. For example, walking, swimming, Tai Chi and other exercise methods can improve the flexibility and stability of the elderly's body, while moderate strength training and stretching exercises can also help enhance the muscle and bone health of the elderly.

3. Quit smoking: Smoking accelerates aging, and with the cumulative effect of time, smoking has a greater impact on the elderly, leading to a higher incidence of diseases such as coronary heart disease, pneumonia and cancer. It is never too late to quit smoking at any age. For the elderly, quitting smoking is a challenge, and recognizing the direct benefits of quitting smoking and the encouragement and supervision of caregivers are the keys to their success in quitting smoking.

4. Sleep: The sleep of the elderly is characterized by shortened duration, prolonged sleep time, early sleep and early awakening. Because the physical conditions and living habits of the elderly are different, their sleep needs will also vary. If you feel energetic and full of energy after waking up, it means that the sleep quality is good. For elderly people with insomnia, it is recommended to improve their lifestyle. Behaviors that promote healthy sleep include: keeping the room temperature appropriate and the light dim, limiting caffeine intake after lunch, avoiding nicotine and alcohol within 3 to 4 hours before bedtime, avoiding excessive drinking or taking diuretics before bedtime, having a regular work and rest schedule, and engaging in regular physical activities.

5. Weight: The elderly are particularly prone to sarcopenia, which is an increase in body fat and a decrease in muscle mass and strength. It is recommended that the elderly combine increased intake of protein-rich foods with increased physical activity to minimize muscle and bone loss. For obese elderly people, it is recommended to reduce body weight by 5% to 10%.

6. Blood lipids: For extremely high-risk elderly people, that is, those aged ≥75 years with a history of atherosclerotic cardiovascular disease, severe chronic kidney disease, diabetes and target organ damage, it is recommended to control the non-HDL cholesterol level below 2.6mmol/L. The non-HDL cholesterol level of elderly people who are not at extremely high risk should be controlled below 3.4mmol/L.

7. Blood sugar: Elderly people have special blood sugar control because they suffer from multiple diseases at the same time, coupled with cognitive impairment. Intensive hypoglycemic treatment increases the risk of falls, frailty, cognitive impairment, cardiovascular events, and even death in the elderly. Therefore, the goal of blood sugar control in the elderly is to avoid hypoglycemia and hyperglycemia. For elderly people with fewer chronic diseases and stable conditions, glycosylated hemoglobin should be <7.5% and fasting blood sugar <7.2mmol/L.

8. Blood pressure: Elderly patients with hypertension often have elevated systolic blood pressure, while diastolic blood pressure is normal or even low. Therefore, blood pressure control for the elderly emphasizes meeting the systolic blood pressure target while avoiding excessive reduction in diastolic blood pressure. For elderly people with cognitive impairment, functional decline, and frailty, overly strict antihypertensive treatment can lead to hypotension or other adverse reactions. The blood pressure control target for the elderly aged 65 to 79 is <140/90 mmHg, which can be further reduced to below 130/80 mmHg if tolerated; for the elderly aged ≥80 years, or those with cognitive impairment or frailty, it is recommended that their initial blood pressure control target be <150/90 mmHg, and the blood pressure can be further reduced after tolerance.

9. Mental health: Due to changes in social roles and decreased physical function, the elderly often experience loneliness, loss, helplessness and other emotions. It is recommended that the elderly cultivate a variety of interests and hobbies, and seek help and support from family, friends and doctors when they have psychological and emotional problems.

For the "9 key elements of life", the elderly should do what they can according to their own situation. Health is a way of life. Let us work together to embrace a healthier tomorrow.

【References】

[1] LLOYD-JONES DM, ALLEN NB, ANDERSON CAM, et al. Life's essential 8: updating and enhancing the American Heart Association's construct of cardiovascular health: a presidential advisory from the American Heart Association[J]. Circulation, 2022, 146(5):e18-e43.

[2]GAFFEY AE, ROLLMAN BL, BURG M M. Strengthening the pillars of cardiovascular health: psychological health is a crucial component[J]. Circulation, 2024, 149(9): 641-643.

[3] Clinical Nutrition and Health Branch of China Health Management Association, Clinical Nutrition Branch of Chinese Nutrition Society, Editorial Board of Chinese Journal of Health Management. Expert consensus on medical nutrition management of dyslipidemia[J]. Chinese Journal of Health Management, 2023, 17(8): 561-573.

[4] National Geriatrics Center, Chinese Medical Association Geriatrics Branch, Chinese Geriatrics Association Diabetes Professional Committee. Chinese Geriatric Diabetes Diagnosis and Treatment Guidelines (2024 Edition)[J]. Chinese Journal of Diabetes, 2024, 16(2): 147-189.

[5] Hypertension Branch of Chinese Geriatrics Society, Beijing Hypertension Prevention and Treatment Association, National Clinical Research Center for Geriatric Diseases (People's Liberation Army General Hospital, Xuanwu Hospital of Capital Medical University). Guidelines for the Management of Hypertension in the Elderly in China 2023[J]. Chinese Journal of Hypertension, 2023, 31(6): 508-538.