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Address correspondence to: Sarah A. Johnson, PhD, RDN, Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO 80523-1571.
Cardiovascular disease (CVD) is an age-related chronic disease, where advancing age
is the primary risk factor largely due to age-related vascular dysfunction.
During aging, several adverse structural and functional changes occur throughout
the entire vascular system (ie, heart, coronary arteries, peripheral arteries, and
microvasculature); however, two prominent changes to the arteries are emerging as
the most clinically important due to their striking effect on age-related CVD risk:
stiffening of the large elastic arteries (carotid and aorta) and vascular endothelial
dysfunction (Figure 1).
These arterial changes, referred to together as vascular dysfunction, vascular aging,
arterial dysfunction, and/or arterial aging (referred to herein as vascular dysfunction),
contribute to the development of atherosclerosis and hypertension (isolated systolic
hypertension in particular), and can lead to stroke, myocardial infarction, and other
adverse events including death. Mechanisms underlying vascular dysfunction with aging
are complex and multifactorial, but excessive oxidative stress and chronic inflammation
are believed to be the major central contributors.
Certain lifestyle behaviors such as regular physical activity, healthy dietary patterns,
and phytochemical-rich food consumption can help attenuate and in some cases reverse
these processes and reduce age-related CVD risk.
Figure 1Aging leads to vascular dysfunction (endothelial dysfunction and arterial stiffness)
largely through excessive oxidative stress and inflammation. Vascular dysfunction
is antecedent to the development of atherosclerosis and hypertension, and therefore
the development of cardiovascular disease. Cardiovascular risk factors such as hypertension
and obesity can accelerate this process. Diet, food, and nutrition-related intervention
strategies can reduce cardiovascular disease risk by attenuating age-related vascular
dysfunction, in large part, through reducing oxidative stress and inflammation. These
strategies can play a role in primary prevention of cardiovascular disease by mitigating
risk factors, and secondary prevention through improvements in vascular function,
blood pressure, and other atherogenic processes. NFκB=nuclear factor κB. ROS=reactive
oxygen species. TNF-α=tumor necrosis factor-α. VCAM-1=vascular cell adhesion molecule-1.
Endothelial function and dysfunction. Part II: Association with cardiovascular risk factors and diseases. A statement by the Working Group on Endothelins and Endothelial Factors of the European Society of Hypertension.
Vascular endothelial estrogen receptor alpha is modulated by estrogen status and related to endothelial function and endothelial nitric oxide synthase in healthy women.
Endothelial function and dysfunction. Part I: Methodological issues for assessment in the different vascular beds: A statement by the Working Group on Endothelin and Endothelial Factors of the European Society of Hypertension.
Levels of asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor, and risk of coronary artery disease: A meta-analysis based on 4713 participants.
Pulse wave velocity is an independent predictor of the longitudinal increase in systolic blood pressure and of incident hypertension in the Baltimore Longitudinal Study of Aging.
Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group.
The effect of dietary approaches to stop hypertension (DASH) diet on weight and body composition in adults: A systematic review and meta-analysis of randomized controlled clinical trials.
Changes in endothelial function, arterial stiffness and blood pressure in pregnant women after consumption of high-flavanol and high-theobromine chocolate: A double blind randomized clinical trial.
Blueberries improve endothelial function, but not blood pressure, in adults with metabolic syndrome: A randomized, double-blind, placebo-controlled clinical trial.
Intake and time dependence of blueberry flavonoid-induced improvements in vascular function: A randomized, controlled, double-blind, crossover intervention study with mechanistic insights into biological activity.
Daily blueberry consumption improves blood pressure and arterial stiffness in postmenopausal women with pre- and stage 1-hypertension: A randomized, double-blind, placebo-controlled clinical trial.
A single serving of blueberry (V. corymbosum) modulates peripheral arterial dysfunction induced by acute cigarette smoking in young volunteers: A randomized-controlled trial.
Meta-analysis of the effects of foods and derived products containing ellagitannins and anthocyanins on cardiometabolic biomarkers: Analysis of factors influencing variability of the individual responses.
Curcumin supplementation improves vascular endothelial function in healthy middle-aged and older adults by increasing nitric oxide bioavailability and reducing oxidative stress.
This article was written by Sarah A. Johnson, PhD, RDN, assistant professor and director, Functional Foods and Human Health Laboratory, and Nicole S. Litwin, MS, RDN, a doctoral degree candidate, both at the Department of Food Science and Human Nutrition, Colorado State University, Fort Collins; and Douglas R. Seals, PhD, professor and director, Integrative Physiology of Aging Laboratory, Department of Integrative Physiology, University of Colorado-Boulder.
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT There is no funding to disclose.
AUTHOR CONTRIBUTIONS S. A. Johnson and N. S. Litwin wrote the first draft of the manuscript with contributions from D. R. Seals. All authors reviewed and commented on subsequent drafts of the manuscript.
