Staving Off Heart Problems in your 80s and Beyond

Older Americans, particularly those in their 80s and older, constitute the fastest-growing segment of the population in the United States. This demographic shift comes with an increased likelihood of health issues, including heart-related problems. The approach to preventing and treating heart disease in octogenarians, individuals aged 80 and older, is generally similar to recommendations for younger individuals.

According to Dr. Patrick O’Gara, a cardiologist at Harvard-affiliated Brigham and Women’s Hospital, there is a clear benefit to addressing factors like high blood pressure, elevated LDL cholesterol, and diabetes in individuals in their 80s and older. Lowering these risk factors can contribute to reducing the risk of heart-related issues. Similar to younger individuals, medications may be necessary to achieve recommended targets for blood pressure and other parameters. However, emphasizing lifestyle habits that mitigate heart-related risks remains a central focus, irrespective of age.

Stay active

Maintaining a consistent regimen of regular physical exercise is arguably one of the most crucial habits for heart health, according to Dr. Patrick O’Gara. Regular physical activity contributes to improvements in various risk factors for heart-related issues. Exercise has positive effects on mood, sleep quality, and duration, all of which are beneficial for heart health.

Activities such as walking or other exercises that elevate heart rate help regulate blood pressure. Additionally, exercises focused on core strength, such as wall push-ups, can enhance balance and reduce the risk of falls. In individuals aged 65 and older with coronary artery disease, falls occur at a rate of 34%, compared to 12% in older adults without heart problems, according to a study.

Frailty, characterized by weakness, fatigue, and wasting, becomes more prevalent with age. For individuals who are frail or have been inactive for an extended period, gentle exercises tailored to older, frail individuals can be beneficial. For specific exercises, one can refer to resources like the September 2021 Heart Letter.

Medication adjustments

Polypharmacy, defined as taking five or more medications, is a common issue in older adults. Around the age of 70, it is advisable to conduct a comprehensive medication review with a physician to determine if any adjustments are necessary. For instance, individuals who started taking a daily low-dose aspirin in middle age to prevent a heart attack might reconsider this practice once they reach the age of 70. At this point, the risk of bleeding may outweigh any potential protection against heart attack or stroke, particularly if there is no evidence of atherosclerosis. Bleeding risks associated with aspirin can range from minor issues like bleeding gums or increased bruising to more serious complications such as bleeding in the stomach, small intestine, or, in rare cases, the brain.

For individuals taking anti-clotting medications to address atrial fibrillation, a heart rhythm disorder increasing the risk of stroke, the bleeding risk is also a concern. Upon reaching the 80s, it might be sensible to consider lowering the dose of anti-clotting drugs to minimize the risk of bleeding. Changes in weight and declining kidney function, which can occur with age, can affect the dosing of certain medications.

Although current guidelines recommend aiming for a blood pressure reading of 130/80 or lower, this target might be too aggressive for some individuals in their 80s and older. Aging bodies tend to be less forgiving, making individuals more susceptible to side effects such as dizziness or lightheadedness from blood pressure medications. If such side effects occur, it is essential to collaborate with a doctor to adjust the dosage accordingly.

Intervention timing

For octogenarians, the timing of invasive heart-related procedures, such as aortic valve replacement, is an important consideration. Traditionally, the practice was to delay such procedures until symptoms became significantly debilitating, impacting the individual’s quality of life. However, waiting too long could lead to increased age and frailty, making valve replacement surgery too risky. The advent of a less invasive alternative, transcatheter aortic valve replacement (TAVR), has expanded eligibility for older individuals.

There is a growing trend to consider TAVR sooner rather than later, aiming for what Dr. O’Gara refers to as “the golden moment.” This moment represents the age at which a person is likely to recover easily from the procedure and still has a good decade ahead. The availability of TAVR has shifted the paradigm, providing a less invasive option that can improve the quality of life for older individuals with aortic valve issues.

Longevity advice

Some of Dr. O’Gara’s patients who have lived beyond 100 years exhibit lifestyle factors that contribute to their longevity. In addition to receiving good medical care, these centenarians engage in regular exercise, participate in volunteer work, and enjoy various social activities. The combination of physical activity, social engagement, and a sense of purpose and belonging in their community may play a role in promoting their longevity. This highlights the potential impact of a holistic approach to health, encompassing both medical care and lifestyle choices, in supporting individuals to live longer, healthier lives.