Unhealthy habits and obesity can potentially accelerate heart aging by up to 45 years
Keeping an eye on your heart's health is crucial for early detection of potential issues and finding effective interventions.
A recent study aimed to find a method to determine a person's heart's functional age compared to their biological age.
This study employed a model based on cardiac magnetic resonance imaging (MRI) and discovered that certain health issues, such as obesity and atrial fibrillation (AFib), as well as an unhealthy lifestyle, can quicken the heart's functional age.
Healthy participants typically had heart ages similar to their real age, while those with health problems often saw heart ages higher than their chronological age. For instance, people with a body mass index (BMI) of 40 or higher had a functional heart age 45 years older than their actual age.
The findings were published in the European Heart Journal Open.
Calculating Heart Age with Cardiac MRI
Researchers in this retrospective observational study investigated a way to measure the age of people's hearts and the differences between healthy and unhealthy aging processes. They noted that specific modifiable risk factors, like high blood pressure, can accelerate the heart's aging. A potential tool for examining how the heart appears and performs is cardiac MRI.
The study compared a healthy reference population of 191 participants with 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, enabling researchers to look at various components of heart structure and function. They then developed a model to determine participants' heart ages and performed statistical analyses.
There were distinct differences between healthy and unhealthy heart groups. For example, the unhealthy group had a higher median ejection fraction, which relates to the percentage of blood the left ventricle pumps out with each contraction.
The final model considered left atrial end-systolic volume and left atrial ejection fraction, both evaluating the heart's left upper chamber's function. These factors were significantly related to age among 169 healthy participants.
Health Conditions Speed Up Heart Aging
Researchers found that healthy participants' heart ages were roughly equal to their real age, while unhealthy participants had heart ages higher than their actual age. A heart's functional age, as determined by cardiac MRI, was almost five years older than an unhealthy participant's actual age.
Obesity seemed to increase the functional heart age, with more weight leading to more years of heart aging. Participants with a BMI of 40 or higher had a functional heart age 45 years higher than their chronological age. People with AFib also had a higher functional heart age than healthy participants.
Functional heart age was sometimes higher for certain comorbidities in specific age groups. For instance, high blood pressure increased functional heart age compared to healthy participants in the same age group for those between 30 and 69 years old. Diabetes increased functional heart age for participants between 30 and 69, with the most significant increase seen in the 40 to 49-year-old group. However, in the 70 to 85-year-old group, participants with diabetes and high blood pressure had lower functional heart ages than healthy participants of the same age.
Study author Pankaj Garg, MD, PhD, Associate Professor in Cardiovascular Medicine at the University of East Anglia in Norwich, UK, shared some key findings:
"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!"
Limitations of the Study
While the study offers promising possibilities for more effective cardiac health monitoring, it also has limitations. First, it used estimations and estimated the functional age of the heart. Second, as it was not a long-term study, there's a risk of survivor bias, which could underestimate how much comorbidities affect older people. Thirdly, researchers didn’t measure how long participants had had the measured comorbidities, so it's possible that there was variation among unhealthy participants regarding their comorbidity exposure. Additionally, bias is noted in some calculations, and selection bias is mentioned. Researchers also acknowledge that changes in factors like exercise and diet were not assessed.
Finally, there may have been variation in the unhealthy group due to medical treatments.
Researchers had certain exclusion and inclusion criteria in place, which influenced 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. The development of the age calculation model involved making several decisions, and researchers may identify areas for improvement.
Cardiologist Patrick Kee, MD, PhD, who was not involved in the study, noted several potential limitations, including the 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 understanding how lifestyle changes could affect outcomes. Patrick Kee added that:
"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."
Test May Help Early Detection and Promote Heart-Healthy Actions
Cardiac MRI's ability to determine the functional age of the heart has the potential to be a valuable preventive measure, according to 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 not involved in the study:
"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 the response to clinical therapeutics and interventions."
Using cardiac MRI has an appeal due to its noninvasive nature, needing only a few minutes for the test. Cheng-Han Chen explained:
"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 many people quickly. That might help catch heart trouble early and stop bigger problems, like heart failure, later on."
Finally, there could be improved communication between doctors and patients at risk for heart problems:
"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
- The study employed a model based on cardiac magnetic resonance imaging (MRI) to determine a person's heart's functional age compared to their biological age.
- Healthy participants typically had heart ages similar to their real age, while those with health problems often saw heart ages higher than their chronological age.
- For instance, people with a body mass index (BMI) of 40 or higher had a functional heart age 45 years older than their actual age.
- The final model considered left atrial end-systolic volume and left atrial ejection fraction, both evaluating the heart's left upper chamber's function.
- Obesity seemed to increase the functional heart age, with more weight leading to more years of heart aging.
- People with AFib also had a higher functional heart age than healthy participants.
- Functional heart age was sometimes higher for certain comorbidities in specific age groups.
- The study had limitations, including the use of estimations, the risk of survivor bias, the lack of assessment of changes in factors like exercise and diet, and variation in the unhealthy group due to medical treatments.
- Cardiac MRI's ability to determine the functional age of the heart has the potential to be a valuable preventive measure.
- Using cardiac MRI has an appeal due to its non-invasive nature, needing only a few minutes for the test.
- By comparing a patient's 'functioning heart age' with their 'chronological age,' clinicians can effectively communicate 'cardiovascular risk' to encourage lifestyle and therapeutic modifications.
