Download Blood Pressure

The Biology of Aging
Week 3
PRESENTED BY
DR. SARAH VADEBONCOEUR,
NATUROPATHIC DOCTOR
Lecture Overview
Heart Health & Blood Pressure
Age related changes in the cardiovascular system
Risk factors for heart disease
Hormonal Changes
Sexual Health
Overview of Cardiovascular System
 Consists of: the heart, arteries, veins, capillaries
Overview of Cardiovascular System
HEART
 Approximately the size of your fist
 Consists of 4 chambers
 2 Atria: superior chambers
Receiving chambers
 Receive blood from veins


2 Ventricles: inferior chambers
Pumping chambers
 Send blood through the body via arteries

Overview of Cardiovascular System
BLOOD VESSELS
1. Arteries: carry oxygenated blood away from the
heart
2. Veins: carry unoxygenated blood towards the
heart
3. Capillaries : link between arteries and veins

Transport materials (oxygen, nutrients) to and from the
cells
Flow of Blood through the Body
Blood arrives to the heart from veins
Right atrium  Right ventricle  Lungs
Lungs  add oxygen, remove CO2
Lungs  Left atrium  Left ventricle
Left ventricle  Aorta  systemic circulation
Heart Circulation
 Coronary circulation is the functional blood
supply to the heart muscle itself
 Collateral routes ensure blood delivery to heart
even if major vessels are occluded
Blood
1. Plasma
 Liquid
portion of the blood
 Contains clotting factors, hormones, antibodies,
dissolved gases, nutrients and waste
2. Red Blood Cells
 Carry
hemoglobin and oxygen
 Live only about 120 days
 Can not repair themselves
Blood
3. White Blood cells
 Fight
infection
 Formed in the bone marrow
 Five
types – neutrophils, lymphocytes,
eosinophils, basophils, and monocytes
4. Platelets.
 Formed
in the bone marrow
 Clot Blood by sticking together
What makes our heart beat?
 Heart muscle:
 Is stimulated by nerves and is self-excitable
 Calcium plays important role in contracting heart muscle
 Heart is stimulated by the sympathetic nervous
system cardioacceleratory center
 Heart is inhibited by the parasympathetic
cardioinhibitory center
Heart Rate/Pulse
 Ideal resting heart rate: 60-100 beats per minute
 Fast heart rate = 100 +
 Caffeine

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
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Stress, anxiety, excitement, or exercise
Excessive thyroid medications/Hyperthyroidism
Warmer temperatures
Cortisol, epinephrine and thyroxine
 Slow heart rate = < 60
 Athletes
 Hypothyroidism
 Beta-blocker medication (blocks adrenaline)
 Sedatives (e.g. alcohol)
 Parasympathetic nervous system activity
 Vagus nerve
Blood Pressure
 Top number = systolic blood pressure
 Pressure when the heart contracts
 Bottom number = diastolic blood pressure
 Pressure when the heart is relaxed
122/78
Blood pressure: what’s normal?
 Ideal blood pressure = less than 120/80
What causes high blood pressure?
 High Stress levels

Cortisol increases potassium loss while retaining sodium in the cell
 Kidney disease
 Nutrient deficiencies

Low magnesium, low potassium, high sodium
 High cholesterol / Atherosclerosis
 Tumours
 Overweight / Obesity
 Hyperthyroid
 Dehydration (constricts blood vessels)
 Genetics
Blood pressure: what’s normal?
 Is low blood pressure dangerous?
 Generally safer than high blood pressure
 Low blood pressure = < 90/60
 May be associated with dizziness and fainting
 Causes of low blood pressure
 Low cortisol/stage 3 stress
 Excessive blood pressure medication
 Hypothyroidism
Aging Effects on the Heart
 The heart has a natural pacemaker system that
controls the heartbeat



This system may develop fibrous tissue and fat deposits
Pacemaker loses some of its cells
Can result in a slightly slower heart rate
 Increase in the size of the heart (especially the left
ventricle)



Heart wall thickens
Amount of blood that the chamber can hold may decrease
despite the increased overall heart size
The heart may fill more slowly
Aging Effects on the Heart
 Abnormal rhythms (arrhythmias) are more common
in older people

They may be caused by heart disease
 Heart muscle cells degenerate slightly
 The valves inside the heart can thicken and become
stiffer

Heart murmur caused by valve stiffness is fairly common in
the elderly
Aging Effects on Blood Vessels
 Baroreceptors: monitor and change blood pressure



Become less sensitive with aging
May explain why many older people have orthostatic hypotension
Causes dizziness because there is less blood flow to the brain
 The capillary walls thicken slightly

May cause a slightly slower rate of exchange of nutrients and wastes
 Aorta becomes thicker, stiffer, and less flexible



Raises blood pressure & makes the heart work harder
May lead to thickening of the heart muscle (hypertrophy)
Most elderly people have a moderate increase in blood pressure
Aging Effects on the Blood
 Blood itself changes slightly
 Reduction in total body water -> blood volume decreases
 Production of red blood cells is slower
 Slower response to blood loss and anemia
 White blood cells stay at the same levels
 Reduced neutrophils = decreased immunity again bacterial
infections
Cardiovascular Disease
Heart Attack (Myocardial Infarction)
 Most often caused by a blood clot
 Blocks one of the coronary arteries
 Coronary arteries bring blood and oxygen to the
heart
 Blood flow is blocked -> the heart is starved of
oxygen and heart cells die
Cardiovascular Disease
Symptoms of Heart Attack
#1: Chest pain

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


The pain can be severe or mild.
A tight band around the chest
Bad indigestion
Something heavy sitting on your chest
Squeezing or heavy pressure
Cardiovascular Disease
Symptoms of Heart Attack
 Other symptoms of a heart attack can include:
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Anxiety
Cough
Fainting
Light-headedness, dizziness
Nausea or vomiting
Palpitations (feeling like your heart is beating too fast or
irregularly)
Shortness of breath
Sweating, which may be very heavy
Cardiovascular Disease
Symptoms of Heart Attack
 Women may experience different symptoms

Can present as abdominal pain vs chest pain
 Women who appeared anxious upon admittance to
the hospital tended to have delays in crucial care


Women who appeared anxious upon admittance to the
hospital tended to have delays in crucial care
“Men underwent electrocardiograms (ECGs) within 15
minutes and clot-dissolving therapy within 21 minutes,
compared with 28 minutes and 36 minutes, respectively, for
women”
Cardiovascular Disease
STROKE
 Blood flow to your brain stops
 Within minutes -> brain cells begin to die
 2 Types of stroke:

Ischemic Stroke
More common
 Caused by a blood clot that blocks a blood vessel in the brain


Hemorrhagic stroke

Caused by a blood vessel that breaks and bleeds into the brain
 "Mini-strokes" or transient ischemic attacks (TIAs),
occur when the blood supply to the brain is briefly
interrupted
Cardiovascular Disease
 Symptoms of stroke are:
 Sudden numbness or weakness of the face, arm or leg
(especially on one side of the body)
 Sudden confusion, trouble speaking or understanding speech
 Sudden trouble seeing in one or both eyes
 Sudden trouble walking, dizziness, loss of balance or
coordination
 Sudden severe headache with no known cause

STROKE = medical emergency!
Blood Disorders
 Anemia - lack of iron in the blood, low RBC count
 Can be causes by chronic disease and blood loss
 Hemophilia - bleeder’s disease, due to lack of
fibrinogen in thrombocytes
Atherosclerosis
 Hardening of the arteries
 Occurs when fat, cholesterol,
and other substances build up
in the walls of arteries -> plaques
 Plaques  calcify  vessels hard & brittle
 Risk factors: cigarette smoking, high
fat/cholesterol diet, hypertension
Coronary Artery Disease (CAD)
 Most common type of heart disease
 CAD -> arteries that supply blood to heart muscle become




hardened and narrowed
Due to the buildup of cholesterol and other material, called
plaque, on their inner walls (atherosclerosis)
Increased plaque -> decreased blood flow through the arteries
Heart muscle can't get the blood or oxygen it needs.
Leads to chest pain (angina) or a heart attack.

Most heart attacks happen when a blood clot suddenly cuts off the hearts'
blood supply, causing permanent heart damage.
 Over time, CAD can also weaken the heart muscle and contribute
to heart failure and arrhythmias.
Congestive Heart Failure
 Heart can't pump enough blood to meet the body's needs
 Does not mean that your heart has stopped or is about to
stop working
 Causes of CHF:




Coronary artery disease
High blood pressure
Multiple myocardial infarcts (heart attack)
Diabetes
 Risk factors:
 65 years +
 African Americans
 Overweight
 Men > Women
Congestive Heart Failure
 Left side heart failure
Less effective pump so more blood remains in ventricle
 Heart is overstretched & even more blood remains
 Blood backs up into lungs as pulmonary edema
 Suffocation & lack of oxygen to the tissues

 Right side failure

Fluid builds up in tissues as peripheral edema
Heart Disease Stats
 According to Heart & Stroke Foundation:
 Good News:
 Since 1952: Cardiovascular death rate in Canada has
declined by more than 75 per
 Nearly 40 per cent in the last decade
 Largely due to research advances in surgical procedures, drug
therapies and prevention efforts
 Bad News:
 Every 7 minutes in Canada, someone dies from heart disease
or stroke
Heart Disease Stats
 Heart disease and stroke are two of the three leading
causes of death in Canada
 In 2008 cardiovascular disease accounted for

29% of all deaths in Canada
 In 2008, of all cardiovascular deaths
 54% were due to ischemic heart disease
 20% to stroke
 23% to heart attack
Risk Factors for Heart Disease
 Non-modifiable risk factors include:
 Male sex
 Older age
 Family history of heart disease
 Post-menopausal
 Race (African Americans, American Indians, and Mexican
Americans are more likely to have heart disease than
Caucasians)
Risk factors for cardiovascular disease
 Nine in 10 Canadians (90%) have at least one
modifiable risk factor for heart disease or stroke

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Smoking
High LDL, or "bad" cholesterol and low HDL, or "good"
cholesterol
Uncontrolled hypertension (high blood pressure)
Physical inactivity
Obesity (more than 20% over one's ideal body weight)
Uncontrolled diabetes
High C-reactive protein
Uncontrolled stress and anger
What is cholesterol?
 Waxy, fat substance
 Found in all cells in the body
 Helps to heal damage in the body
 Backbone for hormones (estrogen, progesterone,
testosterone)
 Involved in the production of vitamin D
 Helps to make bile (important for digestion of fats)
Cholesterol: what’s optimal?
 Total cholesterol = < 5.2
 Triglycerides < 1.7
 HDL cholesterol > 1.3
 LDL cholesterol: depends on risk level
 Calculated based on other values so can be inaccurate
How to Measure Overall Risk
 Framingham Risk
 Calculates overall risk of developing cardiovascular disease over next 10
years


< 10 % = low risk
> 20% = high risk
 Takes several risk factors into account:
 Age
 Gender
 Total cholesterol
 HDL cholesterol
 Smoking status
 Diabetes
 Systolic blood pressure
 Treatment for high blood pressure
 Risk doubles if 1st degree relative with heart disease < 60 yrs
How to Measure Overall Risk
 My cholesterol is high, is my risk increased?

LDL on its own is a very poor estimator of cardiovascular risk


Doesn’t take into account different types of LDL
 Large LDL molecules = safer
 Small LDL molecules = dangerous
Total cholesterol : HDL ratio better predictor
How to Measure Overall Risk
 Causes for elevated small particle LDL
 High triglycerides
 Poor thyroid function


Affects liver production and clearance from body
Infections
H. Pylori
 Herpes virus

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Digestive issues
Genetics
The Cholesterol Myth
 Most researchers now believe the primary causes of
heart disease are inflammation and oxidative stress
 “The cholesterol factor is of minor importance as a
risk factor in CVD. Of far more importance are
smoking, hypertension, obesity, diabetes, insufficient
physical activity, and stress.”
~Frederick Stare, American Heart Association
Where does Cholesterol Come From?
MYTH:
High Cholesterol is due to eating too much cholesterol
 Framingham Heart Study: demonstrated that intake of cholesterol
in the diet had absolutely no correlation with heart disease.
Where does cholesterol come from?



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Liver makes ~70% of cholesterol in the body!
75% of population = no relation between cholesterol intake and
blood cholesterol
25% are “hyper responders”
Dietary fats
Cholesterol: doesn’t raise blood levels of cholesterol
 Saturated fats & trans fats: can increase liver production of cholesterol

What does cause high cholesterol?
 Smoking
 Physical Inactivity
 Genetics
 Diabetes
 Abdominal Obesity
Statin Medications
 Statins block LDL production in the liver
 Lowering LDL may have little to no benefit in reducing risk
(especially for women)
 Low cholesterol can increase the risk of death, especially in
women and the elderly
 Statin medications have side-effects and long-term
consequences
Muscle pain and damage
 Liver damage
 Increase blood sugar levels and risk for Type 2 Diabetes (48%
increase in women)
 Cognitive (brain-related) impairment, such as memory loss,
forgetfulness and confusion

Statin Medications
 Only group with significant benefit = men with
history of heart attack

Reduces risk of 2nd heart attack by 1/3
 In other groups:
 NNT = 83-1000
 Need to treat 83-1000 people with statins for 1 year in order to
save 1 life
Is Aspirin a better choice?
 Aspirin
 Doesn’t prevent cardiovascular event in those with no history
of heart attack.
 NNT = 120
 120 people have to take aspirin to prevent one case of
cardiovascular disease
 However, there is one “bleeding event” for every 73 people
 No significant difference in mortality
 Cochrane Collaboration found that anti-hypertensive drugs
used to treat mild hypertension (140–159 / 90–99 mm/Hg)
did not reduce disease complications or the risk of death
Strategies for Preventing
Cardiovascular Disease
Preventing Heart Disease
 Quit Smoking
 Limit alcohol intake
 Men: no more than 3 drinks per day, 15 per week
 Women: no more than 2 drinks per day, 10 per week
Preventing Heart Disease
 Maintain a healthy weight/waist
 Men: < 40 inches
 Women: < 35 inches

Asian descent: subtract 5 inches
 Waist-to-Hip Ratio
 Men: > 1
 Women > 0.8
Consume a Heart Healthy Diet
 The Mediterranean diet
 Can help to prevent ~ 30 percent of heart attacks, strokes and
deaths from heart disease in high risk individuals
 Benefits are conferred even if:
No weight loss
 Currently using statins, blood pressure or diabetes drugs

 Low-fat diets have not been shown in any rigorous
way to be helpful, and they are also very hard for
patients to maintain
Consume a Heart Healthy Diet
 The Mediterranean diet emphasizes:
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Eating primarily plant-based foods, such as fruits and
vegetables, whole grains, legumes and nuts
Replacing butter with healthy fats, such as olive oil
Using herbs and spices instead of salt to flavor foods
Limiting red meat to no more than a few times a month
Eating fish and poultry at least twice a week
Drinking red wine in moderation (optional)
Load Up on Healthy Fats
 Don’t eat a low-fat diet!
 Needed for satiety
 Important for weight loss
 Contribute to health
 They taste good!
 Help us to absorb fat-soluble vitamins and nutrients

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E.g. vitamins A, D, E, K, lycopene
Important for brain function
Provide backbone for hormones
Fats
 3 Types of fat
 Unsaturated (mono- and poly-unsaturated)
 Saturated
 Trans fat
Fats
 Unsaturated fats

Monounsaturated: avocado, olive oil, nuts/seeds


Associated with lower cardiovascular risk
Polyunsaturated:

Omega 3: salmon, sardines, herring, mackerel, flax, walnuts
 Essential fatty acids: body can’t produce them

Omega 6: vegetable oils (corn, canola, soybean)
 Low intake of omega-3 and high intake of omega-6 fats
can increase heart disease risk
Fats
 Saturated fat: not all bad!
 Found in:
Animal protein
 Dairy products
 Coconut oil
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Good: coconut oil, organic butter
Not so good: animal fats (unless organic, grass fed)
 Health Effects:
 Raises HDL
 Changes LDL from small to larger (safer) molecules
Fats
 Trans Fat: as close to zero as possible
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Worst!
Margarine, processed foods (e.g. Muffins, crackers, chips)
Small amounts found in animal milk
Result of hydrogenation of oils
 Beware of nutrition labels!
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“No trans fat” and “Zero trans fat”
Can contain up to 1 gram trans fat per serving
 Health Effects:
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Decrease HDL
Increase LDL
Increase TG
Butter or margarine?
Butter
Margarine
Saturated Fat
PUFA (omega-6)
Naturally occurring fat
Chemical process
Made by: cows
Made by: chemists
Ingredients: milk fat
Ingredients: vegetable oil along with
emulsifiers, colorants and various
artificial ingredients.
WINNER!
How does food affect cholesterol?
 LDL
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Saturated fats (in excessive amounts and in high risk individuals)
Trans fat
 HDL
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Omega-3
MUFA
Saturated fats
 Triglycerides
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Alcohol
High sugar intake
Refined carbohydrates (bread, pasta, pastries)
Foods to help lower cholesterol
 Almonds/walnuts: small handful or ¼ cup
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Raw, unsalted
 Beta-glucan (oats)
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Steel cut preferred to instant/quick oats
 Soluble fiber: helps with cholesterol elimination
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Aim for 25-30 grams of fiber per day
Beans
Yam/sweet potatoes (with skin)
Brussel spouts
Fruit (e.g. oranges)
Seeds: chia seeds, flaxseeds
Foods to help lower cholesterol
 Olive oil: 1-4 Tbsp. daily
 Soy lecithin: 1 Tbsp. daily
 Soy (50 grams/day)
 Reduced Total cholesterol by 4-10%
 Reduced LDL by 3-6%
 Reduced TG by 10%
 Choose organic soy (ideally fermented like tempeh or miso)
Foods to Help Lower Blood Pressure
 Foods rich in magnesium: 350-500 mg daily
 Nuts, seeds, spinach, beet greens, and chocolate
 Foods rich in potassium: 4,700 mg daily
 Swiss chard, lima beans, potatoes (especially skins), yams,
soybeans, spinach, papaya, pinto beans, lentils, kidney beans
 Celery
 Pomegranate juice
Foods to Help Lower Blood Pressure
 Herbal Teas: Linden tea, Hibiscus tea, Hawthorne
 Consume cold water fish: rich source of omega-3
 Salmon, herring, mackerel, sardines
 Beets/beet juice
 Rich source of nitric oxide
 Nitric oxide = vasodilator = relaxes blood vessels
SALT: friend or foe?
 Evidence supporting a connection between salt
intake and cardiovascular disease is weak at best
 Some evidence suggests that restricting salt too
much may be harmful to our health
 Body requires salt
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Blood pressure regulation
Production of stomach acid
Nerve signalling
 Low blood sodium is dangerous and can be life
threatening
 Daily recommended intake ~1500 mg
Lifestyle habits for Heart Health
 Weight loss
 Exercise

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Reduces blood pressure
Lowers bad cholesterol and raises good cholesterol
 Sleep

Reduces risk of high blood pressure
 Sunlight
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Increases the production of nitric oxide
 Meditation

Calms nervous system -> lowers blood pressure
 Deep breathing.

3-4 fifteen-minute sessions per week of deep breathing can lower
blood pressure long-term
What are hormones?
 Hormones are messengers!
 Made in one part of the
body
 Effect on another part of
the body
 Where do hormones come
from?
Hormones & Aging
 Response to hypothalamus hormones decreases
 Metabolism slows over time, beginning at around
age 20
 Parathyroid hormone levels rise
 PTH raises blood calcium levels by releasing calcium from
your bones and increasing the amount of calcium absorbed
from your small intestine
 May contribute to osteoporosis
Hormones & Aging
 Fasting blood sugar levels increase up to 1 point for
each 10 years after age 50.

Cells become less sensitive to the effects of insulin
 Aldosterone release decreases with age
 Aldosterone regulates fluid and electrolyte balance.
 Can contribute to light-headedness and a drop in blood
pressure with sudden position changes
 Cortisol release also decreases with aging, but the
blood level of this hormone stays about the same

Keep in mind stress levels will impact cortisol levels
Hormonal Changes in Women
 Decreasing levels of estrogen & progesterone
 Causes the ovaries and uterus to shrink
 Tissues of the vagina become thinner, drier, and less elastic
 Severe cases can lead to itching, bleeding, pain during
intercourse, and a need to urinate immediately
 Breasts become less firm and more fibrous, and they tend to
sag
 Lower estrogen levels can also increase risk for:
Osteoporosis
 Heart disease

Hormonal Changes in Men
 Hormonal changes are more gradual in men
 Decreases testosterone results in:
 Fewer sperm
 Decreased sex drive (libido)
 Although blood flow to the penis tends to decrease, most men
can have erections and orgasms throughout life
 Erectile dysfunction can be a sign of vascular disease or
diabetes
 Increase estrogen activity
 Can contribute to prostate enlargement
Sexual Health
 Good indicator of overall health
 Although sexual intercourse appeared to become
significantly less frequent with increasing age, age did
not seem to have an influence on men’s satisfaction

Women: proportion satisfied with the frequency of sexual
intercourse increased with age.
 Among respondents aged 60 years +

58% of men and 41% of women attached the same level of
importance to Sex (“very important “or “absolutely essential”)
 Sexual satisfaction positively linked to satisfaction with
overall physical health, family life and financial wellbeing
Hormone Balancing Tips for Men & Women
 Liver friendly foods
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Cruciferous vegetables: broccoli, cauliflower, cabbage, Brussel spouts
Lemon (add to water)
Grapefruit: caution if taking medications
 Load up on fiber-rich foods
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Chia seeds, fruit, vegetables, beans/legumes, whole grains
Fiber feeds healthy bacteria that are important for hormone health
 Consume healthy fats every day
 Get enough sleep
 Avoid exposure to hormone disrupting chemicals

BPA, pthalates, parabens
Hormone Balancing Tips for Women
 Ground flaxseeds: 2 Tbsp. daily
 Organic soy products
 Contain phytoestrogens
 Caution if history of breast cancer
 Keep stress levels under control
 Cortisol steal
 Choose personal care products that are free of
hormone disrupting chemicals

Average women uses more than 12 products every day
Hormone Balancing Tips for Men
 Increase intake of foods rich in zinc:
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Zinc important for testosterone production
Oysters, pumpkin seeds
 Other nutrients important for testosterone production:
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Selenium: Brazil nuts (2-3/day)
Beta-carotene: all yellow-orange fruit and vegetables
Vitamins C: citrus fruit, strawberries, papaya, broccoli, bell peppers
Vitamin E: Sunflower seeds, almonds, spinach, Swiss chard
 Exercise regularly

Weight/strength training can help raise testosterone levels
Next Week
The digestive system
Nutrition Changes over the adult lifespan
Immune System
Nutrient Deficiencies
References
 National Institute of Health (2012) Aging changes in the heart
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and blood vessels. Retrieved from:
http://www.nlm.nih.gov/medlineplus/ency/article/004006.h
tm
Robert Preidt (March 27, 2014) Women Face Delays in Heart
Attack Care: Study. Retrieved from WebMD:
http://www.webmd.com/women/news/20140317/womenface-delays-in-heart-attack-care-compared-to-men-study
http://www.heartandstroke.com
Mayo Clinic
ChrisKresser.com
http://www.nytimes.com/2013/02/26/health/mediterranean
-diet-can-cut-heart-disease-study-finds.html?pagewanted=all
References
 Dean J. (2013) Sexual Health and Overall Wellness
(SHOW) survey in men and women in selected
European and Middle Eastern countries. Journal of
International Medical Research 41(2) 482–492