Cardiovascular Disease — 11

Once a person is deemed at high risk from this assessment, comprehensive lifestyle+ factors can be promoted and close monitoring can be initiated with a CT scan for coronary artery inflammation, blood markers for body-wide inflammation. More aggressive blood pressure management, targeting less than 120 mm Hg, has been shown to prevent major vascular events in large randomized trials. High-intensity statin and, if unresponsive, anti-inflammatory drugs such as colchicine can potentially be used, especially if there are persistent elevated markers of inflammation, despite aggressive efforts to improve lifestyle. Better anti-inflammatory drugs or gut microbiome modulation will undoubtedly be available in the future. Such a heart disease forecasting effort reflects the primacy of inflammation as a driver, along with the opportunity to suppress it during the long process that it takes for atherosclerosis to declare itself. We’re not doing this yet, but it’s the path to prevention or delay of a major age-related disease.

ATRIAL FIBRILLATION

There’s another heart condition that is age related, common, more heritable, and more preventable than generally acknowledged. Atrial fibrillation is the heart rhythm abnormality that is the leading cause of embolic stroke, with a fivefold increased risk. It affects more than sixty million people worldwide, and more than five million in the United States. Age is the most important risk factor. The risk increases sharply from 0.2 percent for people in their thirties to 4 percent in their seventies. The lifetime risk of this heart rhythm abnormality is nearly 25 percent for adults over the age of forty-five. Besides stroke, AF carries an increased risk for heart failure and mortality. There is expected average loss of 9 life years for people less than or equal to age fifty, and 5.4 years for those age seventy at the time of diagnosis.

Many of the risk factors for this condition overlap with atherosclerotic cardiovascular disease, including age, obesity, hypertension, diabetes, smoking, lack of physical activity, and air pollution. But some risk factors are more specific to atrial fibrillation, including sleep apnea or disorder, thyroid disease, kidney disease, chronic obstructive pulmonary disease, mental health disorders, high intake of sugary beverages, high testosterone in older men, increased height, young elite athletes, extreme endurance exercise, and gum disease. A common misconception is that caffeine intake is associated with atrial fibrillation risk; it is not. If anything, from all the studies available, it is linked to a lower risk. An important, if not surprising, randomized trial showed that weight loss in overweight and obese individuals reduced the recurrence and symptom burden of this particular heart problem.