Several degenerative conditions are primarily caused by advanced age. Particularly in cardiovascular disease, not only aging-associated cause, unhealthy lifestyle habits are also strongly linked to increased risks of heart disease. Other contributing factors to develop cardiovascular conditions include diabetes, hypertension, being obese or overweight and physical inactivity as well as smoking and alcohol consumption. Since cardiovascular disease remains the leading cause of death in the elderly, people aged over 40 should be aware of their possible risks for heart disease. Annual health check-up and heart screening with appropriate programs are crucially vital. Not only to early detect the abnormalities and receive effective treatment in time, but heart screening also largely helps to reduce the chances of serious-life threatening conditions such as heart failure and sudden cardiac death.

Risk factors of cardiovascular disease

Risk factors for developing cardiovascular disease include: 

• Increasing age: Aging is firmly associated with increased risks of damaged and narrowed arteries as well as thickened or weakened heart muscle, leading to several forms of heart disease.
• High blood pressure, known as hypertension: Uncontrolled high blood pressure can potentially result in hardening and thickening of arteries, causing narrowed vessels through which blood flows.
• High blood cholesterol levels: High level of cholesterol in the blood significantly increases the risk of atherosclerotic plaque formation which is made up of fat, cholesterol, calcium and other substances. Over time, plaque hardens and narrows the arteries and limits blood supply to the heart.
• Diabetes: Over time, high blood glucose from diabetes can damage the blood vessels and the nerves that control the heart and blood vessels, resulting heart disease.
• Obesity or overweight: Excess weight typically worsens other risk factors. The mechanisms through which obesity increases cardiovascular risks involve changes in body composition that can affect hemodynamics and alters heart structure and functions.
• Physical inactivity: Lack of physical activity has clearly been shown to be a risk factor for cardiovascular disease.
• Family history of cardiovascular disease: A family history of heart disease increases the risk of coronary artery disease, especially if a parent developed it at an early age. Genetic abnormalities play a major role in this inherited heart disease.
• Stress: Excessive stress that cannot be successfully managed may damage the arteries and worsen other risk factors for heart disease. Chronic stress exposes the body to unhealthy, persistently elevated levels of stress hormones including  adrenaline and cortisol. Studies also link stress to changes in the way blood clots, which increases the risk of heart disease.
• Smoking: Cigarette contains toxic substances that impair health and damage the heart. Nicotine constricts the blood vessels while carbon monoxide can damage their inner lining, making them more susceptible to atherosclerosis. Interestingly, heart attacks are more common in smokers than in nonsmokers.
• Unhealthy diet. A diet that is high in fat, salt, sugar and cholesterol can contribute to the development of heart disease.

Warning signs and symptoms of cardiovascular disease in the elderly

 Abnormal signs and symptoms that might indicate cardiac disease, especially in the elderly include: 

• Feeling tired easily, weakness and fatigue
• Chest pain or chest discomfort
• Changes in heart rhythm, irregular heartbeat, palpitation, pounding or fluttering
• Shortness of breath
• Frequent fainting (syncope) or lightheadedness

Other non-specified symptoms that might be typically seen in elderly patients are dizziness, loss of appetite, nausea and vomiting.

Heart screening and diagnostic tests

The tests to diagnose heart disease depend on suspected conditions. No matter what type of heart disease you have, your doctor will likely perform a physical exam and ask about your personal and family medical history before doing any tests. Besides personal and family medical history, physical examination, blood tests and a chest X-ray, tests to diagnose cardiovascular may include:

1. The identification of calcium and atherosclerotic plaque built up in the lining of the artery wall by using CT scan (computed tomography) scan :
   • Coronary calcium scoring: Cardiac Calcium Scoring is non-invasive CT scan (computed tomography) of the heart used to calculate the risk of developing coronary artery disease by measuring the amount of calcified plaque in the coronary arteries. If high amount of calcified plaque is found, the chances of develop cardiovascular disease increase with other serious complications.
   • CTA for coronary artery: A coronary computed tomography angiogram (CTA) uses advanced CT technology, combined with the injection of intravenous contrast material (dye) to obtain high-resolution 3D pictures of the moving heart and vessels. Injected contrast material helps evaluate the blockages of atherosclerotic plaques as early as possible. As a result, the narrowed or blocked vessels can be treated in time before complications arise.
2. Exercise stress test
   Exercise stress test usually involves physical exercise such as walking on a treadmill or riding a stationary bicycle which is connected to EKG (electrocardiogram). It is a common cardiological test that measures the heart’s ability to respond to external stress in a controlled clinical environment. The result indicates the possibility of blockage in the arteries. Additional tests are necessarily required to make a confirmatory diagnosis.
3. Cardiac Magnetic Resonance Imaging (MRI)
   Cardiac magnetic resonance imaging (cardiac MRI) is a non-invasive test that uses a magnetic field and radiofrequency waves to create detailed pictures of structures inside the heart. Cardiac MRI can be done with or without contrast material. Cardiac MRI with the injection  of contrast material is typically used to detect the abnormalities of heart muscle (myocardium), heart membrane, the aorta and the arteries as well as congenital heart defects, defects in the structure of the heart or great vessels that is present at birth.

Unhealthy habits that potentially increase risks of cardiovascular disease 

1. Excessive or chronic stress that cannot be manage properly.
2. Over consumption of poor diets e.g. diets in high sugar and salt.
3. Fast foods and junk foods such as fatty foods and bakery e.g. donuts.
4. Insufficient amount sleep
5. Physical inactivity
6. Less eating of fiber rich foods e.g. whole-grains, vegetables and fruits
7. Cigarette smoking and alcohol drinking

 
Key tips to keep the heart healthy

Particularly in people with a greater risk for developing heart disease, to greatly lower the risk, the daily nutritional recommendations include: 

• Eating a full ladle of unpolised rice or brown rice which is a highly nutritious grain;
• Consuming proteins obtained from fish 2-4 tablespoon;
• Eating a handful of hard-shell nuts as snacks during meals;
• Having organic vegetables without chemical
• Limiting to eat 6-8 pieces of fruits per meal due to high sugar. Less sweet fruits include dragon fruit, pear, guava, rose apple and apple.
• Drinking enough water, 6-8 glasses per day.

Cardiovascular disease in the elderly imposes a huge burden in terms of mortality, morbidity, disability, functional decline. It is a very common disease in the elderly. Being aware of warning signs combined with lifestyle modifications can substabtially help to strengten heart’s health. Annual check-up and heart screening remains essential in order to detect the abnormalities as early as possible. Early detection does not only increase chances of successful treatment, it also helps to lower risks of other serious complications in the future.