Promoting Heart Health in Older Adults: Strategies for a Stronger Tomorrow

By Michelle Lu, Nurse Practitioner and Primary Care Practitioner

Heart disease is the leading cause of death for both men and women in the United States, where someone has a heart attack every 40 seconds. Approximately 695,000 Americans – or one in every five adults – died from heart disease in 2021. 

“Heart disease” is a catch-all phrase for a variety of conditions that affect the heart’s structure and function. Your body’s complex cardiovascular system – your heart (cardio) and its network of vessels (vascular) – circulates blood throughout your body to deliver oxygen and nutrients to vital organs and muscles, allowing you to live your everyday life. So when we discuss heart health, we also mean the health of the entire body.

Health conditions, lifestyle, and family history all play a role in determining your risk for heart disease. Nearly half of all Americans have at least one of the key risk factors for heart disease: high blood pressure, high cholesterol, diabetes or smoking. 

Heart disease may hit some populations harder than others, especially minority groups. Black Americans, for example, are 30 percent more likely to die from heart disease than White Americans. Hispanic women are more than twice as likely as White women to have diabetes, which is a major risk factor for heart disease. And American Indians are three times more likely than Whites to have diabetes.

Understanding the Aging Heart

Like much of your body, your cardiovascular system and its blood vessels – arteries, veins, and capillaries – can stiffen over time. As a part of the normal aging process, your heart and blood vessels become more susceptible to changes, such as “leaks” in the heart valves that direct blood flow. The aging heart might also experience changes in heart rate or rhythm.  If not managed well, chronic conditions like high blood pressure can cause “remodeling” where the heart muscle itself can change in shape, making it harder to pump blood and nutrients throughout the body. 

All of these changes increase the likelihood of heart disease and other cardiovascular conditions such as stroke, high blood pressure and heart failure. 

Know the Warning Signs

Understanding the different symptoms of a heart attack is crucial for timely intervention. Don’t wait to get help if you experience any of the common warning signs. Some heart attacks are sudden and intense, but others start slowly, with only mild pain or discomfort. Pay attention to your body and call 911 if you experience:

• Squeezing chest pressure or pain
• Jaw, neck or back pain
• Nausea or vomiting
• Shortness of breath 
  
  

Decoding the Gender Divide 

While heart disease is often considered a man’s disease, the numbers don’t discriminate – it’s also the number-one killer of women, responsible for one out of every five deaths per year. While many of the signs, symptoms and risk factors of heart disease are the same for men and women, women may experience other symptoms that are typically less associated with heart attack.

These can include:

• Chest pain (but not always)
• Pain or pressure that is not always in the “chest” - such as the upper abdomen or upper back 
• Fainting
• Indigestion
• Extreme fatigue
  
  

Menopause is a unique risk factor for women. Some risk factors such as obesity, diabetes, metabolic syndrome, and depression happen more often in women. And, women are more likely to have heart disease in the smaller arteries of the heart, called coronary microvascular disease. This can make the disease harder to identify, diagnose, and treat.

Managing Your Heart Health After 65

Keeping your heart healthy is one of the most important things you can do as you age. If you’re 65 or older, you can take steps to improve your heart’s longevity and lower your risk of heart attack. 

• Think about what you can control, and take steps to: 
  • Quit smoking, which causes damage to the heart and blood vessels
  • Follow a heart-healthy diet that is low in sodium and high in vitamins, minerals and fiber, and colorful fruits and vegetables. Limit fatty, fried foods and alcohol. 
  • Engage in regular, daily physical activity, aiming for 150 minutes a week of moderate aerobic exercise, such as brisk walking or other activities you enjoy that get your heart rate up, and two or more strength training sessions a week
    
    
• Manage underlying risk factors including: 
  • Controlling high blood pressure
  • Checking for high cholesterol
  • Monitoring weight and obesity
  • Screening for and treating diabetes
  • If you have one or more of these health problems, work with your primary care provider (PCP) to make healthy changes to lower your risk. Your PCP can help you understand your individual risk factors and work with you to create a plan to reduce your overall risk that may include lifestyle changes and/or medications.
    
    

• Think beyond traditional ‘medical care’ by:
  • Managing and reducing stress 
  • Seeking treatment for depression and anxiety
  • Building your social connections and investing in your relationships – loneliness is a risk factor for heart disease!
    
    

Despite everything we’ve learned about heart disease, more than half of Americans do not know that it is the leading cause of death, according to a November 2023 survey conducted on behalf of the American Heart Association. Even if you haven’t taken the time to focus on your heart health prior to today, it’s never too late to start. Making healthy lifestyle changes, following up regularly with a trusted care provider, and understanding the risks and symptoms can help to prioritize your health – and keep your heart strong at any age. 

Michelle Lu, NP, is a Primary Care Practitioner (PCP) for Patina, which delivers primary care exclusively for adults 65+ enrolled in traditional Medicare or participating Medicare Advantage plans in the Philadelphia and Charlotte areas. She is a graduate of the University of Pennsylvania School of Nursing & The Wharton School and has been a clinician for more than 10 years.