Dr Wong Bun Hung Christopher
Specialist in Cardiology, MBBS (HK), FACC, DABIM, DABIM (Cv), DABIM (Interventional Cardi)
As we grow older, we need to pay attention to our vascular age to keep our body healthy. Keeping blood vessels young and flexible can effectively prevent a variety of cardiovascular diseases.
Every part of our body relies on the continuous supply of oxygen by our blood vessels to maintain a normal function. Vascular ageing causes calcification, hardening, loss of elasticity, plaque build-up (the build-up of fatty deposits) and even blocked supply of blood, resulting in various problems. Cardiologist Dr Christopher Wong explains that vascular age is not necessarily the same as our chronological age. In addition to ageing and functional deterioration, other factors affecting vascular age include genetics, high cholesterol, long-term smoking, hyperglycemia and high blood pressure. The above factors cause our vascular age to be greater than our chronological age.
Methods of Examining Vascular Age
At present, there are 3 ways to determine a person’s vascular age:
1. Pulse Wave Velocity
This method is more commonly used in research centres. Researchers use an instrument to measure the pressure, flow volume and velocity of the blood travelling from the carotid arteries to the femoral arteries. The information is then used to analyse the stiffness of the blood vessel walls. If the arteries are hard with loss of elasticity, the pressure will be greater when the heart is pumping blood. The blood therefore flows faster, with a higher pulse wave velocity recorded.
2. Carotid Intima-Media Thickness (CIMT)
This method is more commonly used by doctors who use ultrasound to measure the thickness of two layers in the carotid arteries called the intima and media. This allows them to estimate the vascular age and vascular stiffness and to check for the presence of plaque build-up in the blood vessels to assess the risk of heart disease or stroke.
3. Framingham Risk Score
This method has been used clinically for many years and is very simple. By examining indicators such as age, sex, total cholesterol, HDL cholesterol and blood pressure, as well as whether he or she is diabetes or a smoker, the likelihood of a heart attack in the next 10 years and the age of the heart is estimated. The score tables can be found online and in mobile apps. As there is no need to use special equipment and a blood test can easily provide information such as cholesterol, blood pressure and blood sugar levels, Dr Wong says we can perform an initial risk assessment on ourselves.
Who Needs Vascular Age Testing?
Obvious symptoms such as angina, excessive panting on exertion and dizziness after exercise will appear only when the blood vessels have hardened by more than 50 per cent to 70 per cent. Therefore, Dr Wong suggests that men over the age of 45 and women aged over 55 should consider an ultrasound exam done on their carotid and leg arteries, even if they are not experiencing any symptoms. These groups of people are considered to be at medium to high risk of cardiovascular diseases and are also more likely to develop high blood pressure and high cholesterol. An ultrasound exam can assess their vascular stiffness and determine the presence of plaque accumulation.
It will be good for people with diabetes to be tested as they usually have cholesterol and triglyceride abnormalities, which will accelerate vascular sclerosis and they are at two to three times risk of heart disease and stroke than an average person. Dr Wong explains that medically, having diabetes is considered to be equivalent to having coronary heart disease and doctors should treat patients with diabetes the same way as they would when managing coronary heart disease, so diabetic patients should pay special attention to their vascular health.
If an ultrasound exam shows that the blood vessels are stiffened, doctors usually prescribe cholesterol-lowering or statin medications, in addition to advising patients to control their diet. The doctors will also advise these patients to repeat the ultrasound exam every six months to two years, according to their conditions, to determine whether the rate of hardening of the blood vessels is under control.
If a patient’s condition is serious, the doctor may advise him or her to undergo further checks – usually computed tomography – to determine whether there is coronary occlusion. Dr Wong highlights that the computed tomography scan involves radiation exposure, which will increase the life-time risk of cancer to a certain extent, albeit to a small extent. Therefore, patients need to have a risk assessment done and should only have the scan done if necessary.
Problems Caused by Vascular Aging
As blood vessels run through the whole body, vascular ageing affects every part of the body. The most direct impact is on the heart, causing problems such as myocardial infarction, angina and heart failure. If the brain does not have enough blood flow, there is a risk of stroke or dementia. If there are renal vascular issues, renal failure or secondary hypertension may ensue.
Furthermore, people who smoke regularly or suffer from severe diabetes are more likely to suffer from peripheral vascular disease, which causes pain in the legs while walking. In severe cases, foot ulcers and gangrene may develop and may even lead to amputation.
Dr Wong explains that in some cases, vascular ageing will affect the large and small intestine, causing patients to develop abdominal pain after eating. However, this usually coexists with other cardiovascular diseases. Generally, stomach aches are not related to cardiovascular problems so there is no need to worry too much.
Reduce the Risk of Cardiovascular Disease
To keep our blood vessels healthy and young, we must start with healthy habits in our daily life. Dr Wong says that the priority is to pay attention to our diet. It is best to consume low saturated fat, low-cholesterol foods and not to eat too much red meat and dairy products. When drinking milk, opt for skim milk. We should also reduce consumption of foods rich in sugar and carbohydrates, and effectively control our blood pressure. Dr Wong also explains that excessive alcohol can increase the blood pressure and at the same time, cause weakening of the heart muscle, therefore his advice is not to drink more than one glass of wine a day.
On the other hand, it is also important to develop the habit of exercising regularly. The American Heart Association recommends at least 150 minutes of exercise per week. Dr Wong highlights the importance of persistence, i.e. exercising for an average of 20 minutes or so every day. He also advises smokers to quit smoking as they have a much higher risk of cardiovascular disease than an average person.
By maintaining good daily habits, we can ensure good vascular health and live healthily and happily every day!