AGING AND CARDIOVASCULAR DISEASES
Today, due to the increase in life expectancy, the elderly population is growing steadily. Aging is a natural and inevitable stage of life, just like childhood and adulthood. The World Health Organization (WHO) defines individuals aged 65 years and older as elderly, and those aged 85 and older as very elderly. Worldwide, declining birth rates, improved living standards, and advances in diagnostic and therapeutic strategies have all contributed to increased longevity and a rapidly expanding elderly population. Currently, individuals aged 65 and above constitute 8.5% of the world’s population. According to projections in the report “An Aging World: 2015,” this proportion is expected to rise to 17% by 2050, reaching a total of 1.6 billion elderly individuals.
According to data from the Turkish Statistical Institute (TÜİK), the population aged 65 and above in Turkey increased from 5,682,003 in 2012 to 6,651,503 in 2016—a 17.1% rise over five years. Of this elderly population, 43.9% are men and 56.1% are women. During the same five-year period, the proportion of elderly individuals in the total population rose from 7.5% to 8.3%. Population projections estimate that the proportion of elderly individuals in Turkey will reach 10.2% in 2023, 20.8% in 2050, and 27.7% in 2075. These data suggest that, in parallel with global trends, the second half of the 21st century will also be the “century of aging” in Turkey.
As age increases, the prevalence of cardiovascular diseases (CVD) rises as well. Globally, mortality due to cardiovascular diseases is 31% before the age of 65, but this figure rises to 81% after age 65. In Turkey, according to the Ministry of Health’s study on the prevalence of coronary heart disease, the prevalence among women aged 55–64 is 6.9%, and among men in the same age group it is 10.9%. Additionally, CVD prevalence among women aged 65–74 is 9.3%, and 18.3% among men; among individuals older than 75, it is 10.8% in women and 19.6% in men. These findings demonstrate that CVD prevalence increases with age and is more common in men than in women.
Aging is one of the most significant risk factors for cardiovascular disease, as progressive structural and functional changes in organs and the vascular system increase the risk of CVD development. Due to increased collagen and decreased elastin content with age, blood vessels—particularly the aorta—lose elasticity and become stiff. These changes cause loss of aortic compliance, leading to increased systolic blood pressure (SBP), decreased diastolic blood pressure (DBP), and increased pulse pressure. A decline in DBP adversely affects coronary perfusion, triggering myocardial ischemia.
Understanding how aging structurally and functionally affects the cardiovascular system may provide opportunities to prevent or reduce the increased risk of CVD in elderly patients. CVD is also closely associated with frailty, a condition characterized by heightened vulnerability to stressors in older adults.
Recent experimental and clinical studies indicate that age-related structural and functional changes in the arteries contributing to CVD development can be grouped into two main categories: widespread endothelial dysfunction and central arterial stiffness.
These diseases can be prevented or mitigated through management of modifiable risk factors. Among these, nutrition plays a crucial role in reducing cardiovascular morbidity and mortality, especially in high-risk individuals. Nutritional programs for elderly individuals with cardiovascular disease should be tailored by a dietitian in collaboration with the patient and, when necessary, their caregiver.
Key Dietary Considerations
Fat Intake
The daily diet typically includes three types of fats: monounsaturated fats (olive oil, hazelnut oil), polyunsaturated fats (sunflower, corn oil, fish oil), and saturated fats (butter, animal fats). Solid margarines contain polyunsaturated fats that have been hydrogenated and therefore do not contain cholesterol; however, they are rich in trans fatty acids, a major cardiovascular risk factor. Polyunsaturated fatty acids—particularly omega-3 fatty acids—have anti-inflammatory, antithrombotic, and antiatherosclerotic effects, delaying atherosclerotic plaque formation and supporting endothelial function. Recommended intake guidelines include:
- 20–35% of daily energy from fats
- Low intake of saturated and trans fats
- Linoleic acid: ≥4% of daily energy
- α-linolenic acid: ≥0.5% of daily energy
- EPA + DHA: 250 mg/day
Carbohydrate Intake
It is recommended that at least half of daily grain consumption be from whole grains. Fiber-rich whole grains (≥1.1 g fiber per 10 g carbohydrate) should be consumed in three or more servings per day, totaling at least 28 grams.
Homocysteine
Elevated homocysteine levels are an independent risk factor for vascular disease. Genetic factors, lifestyle habits (smoking, coffee and alcohol consumption), and nutritional intake (inadequate B6, B12, and folic acid) all affect homocysteine levels. Plasma homocysteine levels are inversely related to folate, B6, and B12 status; thus, adequate intake of these vitamins is essential for cardiovascular health.
Vitamin D Intake
Vitamin D deficiency is an independent risk factor for cardiovascular mortality in the elderly. It is associated with increased renin-angiotensin-aldosterone activity, insulin resistance, and elevated parathyroid hormone levels, contributing to inflammation. Reduced sun exposure and diminished skin synthesis with aging lead to vitamin D deficiency, causing elevated parathyroid hormone levels and promoting myocardial calcification. Vitamin D deficiency also promotes inflammation, contributing to atherosclerosis and CVD development. Dietary intake alone is often insufficient to raise serum 25(OH)D levels to the desired range. Daily supplementation of 400 IU increases 25(OH)D levels by 7–12 nmol/L depending on baseline values. To raise levels from 50 nmol/L to 80 nmol/L, approximately 1700 IU/day is required.
Flavonoid Intake
Flavonoids inhibit lipid peroxidation and slow the progression of atherosclerotic plaque formation. Consumption of flavonoid-rich foods is known to benefit cardiovascular health.
Tea Consumption
Tea, cocoa, and apples are rich in flavan-3-ols, a subgroup of flavonoids. Intake of these foods has an inverse association with cardiovascular disease risk. Among elderly men with existing cardiovascular disease, epicatechin consumption has been shown to reduce cardiovascular mortality by 46%, though this effect has not been observed in individuals without CVD.
Fruit and Vegetable Consumption
High consumption of fruits and vegetables is inversely associated with cardiovascular mortality. Adding one daily serving of fruit reduces CVD risk by 6%, and one serving of vegetables reduces risk by 5%.
Salt Intake
Excessive salt consumption is associated with increased blood pressure. Reducing salt intake leads to significant decreases in blood pressure.
