Friday, April 5, 2019

How do you keep your cardiovascular system healthy from your fifties onwards?

Through robustification!

By making your cardiovascular system robust against aging.
Systems biology defines robustness as “… a property that allows a system to maintain its functions against internal and external perturbations.” [1]
When that “system” is your cardiovascular one, and the “perturbation” is aging then cardiovascular robustness is your ability to maintain cardiovascular function.
Measuring the latter gives you a benchmark to guide you to finding the strategies that work for YOU.
That’s important because not everything does. I’ll get back to that in a minute.
The other nice thing about robustification function is that it is your best bet at maintaining health AND living a little longer in good health.
Just look up the medical definitions of aging and chronic cardiovascular disease. Both share “progressive loss of function” as their key criterion.
So, why haven’t you heard before about robustness in the context of cardiovascular health? Because most medical practitioners and the majority of biomedical scientists haven’t taken note either.
Which is what all systems biologists find rather amusing. And which is why I have made it my vocation to change that (the “taking note” part, not the amusement). 
If you really want to read the heavier stuff on this you’ll find it for example in the Journal of Applied Physiology or others [2,3].
The CV system is unique in that it is the only system of the human organism that connects each and every cell. After all, the CV system’s chief task is to supply every cell of every tissue in every organ with the nutrients, the oxygen and the signaling molecules they need.
To accomplish that, Mother Nature has designed this system as a closed hydraulic system:
Its center piece is a pulsating pump (the heart) that pushes blood through a network of elastic tubes (the arteries).
Keep in mind that it is not the pump that does most of the pushing but the arteries. They expand to receive the heart’s output, and then recoil to push this “bolus” of blood further downstream.
This ability to expand and to recoil, together with the arteries’ ability to change their geometry, is what determines CV function.
In fact, what typically deteriorates first is not the heart. It’s the arteries.
With aging, arteries become stiffer. They progressively lose their elasticity (the correct term is ‘compliance’ but elasticity is easier to visualize), which puts more and more strain on the heart, until that strain becomes intolerable.
Long story short: the physical parameters that define arterial function (predominantly compliance and resistance) are the ones that tell you how slowly or fast you age.
Keep those functional parameters in the green zone, and you will have made your CV system robust against aging.
The only problem: you can’t measure them, yet.
My team and I have developed tools to do just that.
We use a common medical blood pressure measurement technique, such as the ones you know from your doctor’s office, or that you may even use at home to measure your blood pressure.
Until this technology becomes available to everyone, you can only go by what you have right now.
And what you have is blood pressure.
Blood pressure is determined by all those functional markers that I mentioned earlier.
Stiffer arteries means higher pressure.
Greater resistance to flow (for example when arteries are narrowed) means higher pressure.
Now I come back to the point I made earlier: what works for YOU.
Only if you monitor your CV function will you have a guide to what works for you and what doesn’t. Absent any method to monitor function, your second best bet is blood pressure monitoring.
Not every type of exercise, not every dietary or other strategy works the same in any two people.
Here is an example.
Green et. al. investigated the change of CV function (measured as flow mediated dilation, FMD, an indicator for arterial compliance) in 800 individuals following an 8-weeks exercise intervention. The result was a 7% increase in FMD on average. For that marker ‘FMD’ 7% is impressive [4].
Now look at the graph below, which breaks down the result for every one of the participants:
Each vertical bar in this graph represents the change in function of one participant.
Hardly anyone had a 7% change. In fact, the range goes from getting worse to improving by almost 15%.
Now you understand why you shouldn’t go blindly with the recommendations doled out by people who simply parrot what has been published in scientific research.
Aside from the dangers of getting mislead by the pseudo-scientific prattling of food fundamentalists, hardcore exercisers and people in general who present more aspirational versions of themselves, there is an actual need to monitor the effects of whatever you do.
In answering a Quora question related to improving blood pressure I have compiled a little chart that tells you where your CV system’s functional markers should be.
Monitor them regularly and compare their development against anything you do to improve CV health. You will soon find out what works for you.
Now here comes my personal anecdotal evidence.
I am 62, my wife is 64.
We have exercised for the past 20 years almost every day.
For the past 5 years we have practiced intermittent fasting (last meal of the day is at latest 15:00 – 16:00, following day’s breakfast comes at 09:00 after 60-90 minutes exercise, including high-intensity cardio routines and strength training). Breakfast consists of a smoothie that I designed to specifically address arterial function.
Our CV function places us at a biological age of around 40. The same goes for blood biomarker profiles.
Additionally, my wife has preserved the looks and the figure of a much younger age, as you can see from the admittedly amateurish video clip I made a few days ago.
Will that work for you?
It will in all likelihood do you no harm and probably improve your CV robustness. But the most essential point is: monitor your intervention’s effect on the markers of CV function. Even if you have only blood pressure to go by.
And if you are successful, you might even inspire others to pose that same question of yours already at a younger age. Because CV function begins to decline in mid-twenties already.
The earlier you start, the better.
Good luck.

Bibliography
1. Kitano H. Towards a theory of biological robustness. Mol Syst Biol 2007;3:137.
2. Kraushaar LE, Dressel A. The cardiovascular robustness hypothesis: Unmasking young adults’ hidden risk for premature cardiovascular death. Med Hypotheses 2018;
3. Kraushaar LE, Dressel A, Massmann A. A novel principled method for the measurement of vascular robustness uncovers hidden risk for premature CVD death. J Appl Physiol 2018;japplphysiol.00016.2018.
4. Green DJ, Eijsvogels T, Bouts YM, Maiorana AJ, Naylor LH, Scholten RR, Spaanderman MEA, Pugh CJA, Sprung VS, Schreuder THA, Jones H, Cable T, Hopman MT, Thijjssen DH. Exercise Training and Artery Function in Humans: Non-Response and Its Relationship to Cardiovascular Risk Factors. J Appl Physiol 2014;
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