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Cardiovascular aging results from a complex interplay of genetic, and modifiable epigenetic, lifestyle and environmental factors. Here, we summarize 10 evidence-based strategies to support heart and metabolic health during the aging process (Table 1).

Table 1
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Healthy longevity heart code

1. Reduce waist circumference and increase muscle mass

  • Take action to reduce your waistline with endurance exercise and moderate calorie restriction, ensuring you consume the right amount of nutrient-rich calories for optimal functioning.

  • Increase or maintain skeletal muscle mass with resistance exercise.

2. Adhere to a minimally processed Mediterranean-like diet

  • Eat a wide range of vegetables, whole grains, legumes, nuts, and fruits. Avoid refined carbs.

  • Eat mostly proteins from plants (legumes, nuts, and whole grains), alongside fish, seafood, and low-fat dairy; if opting for meat and poultry, choose lean cuts on occasional basis, and avoid processed meat.

  • Avoid ultra-processed foods and beverages, rich in ‘empty’ calories, sugars, and unhealthy fats.

  • Choose and prepare foods with little salt; use iodized salt to promote thyroid health.

  • Use cold-pressed extra-virgin olive oil in moderation, while abstaining from animal fats (butter, cream), tropical oils (coconut, palm) and partially hydrogenated fats.

3. Intermittent fasting and time-restricted feeding

  • If overweight, stop eating at 80% satiety; eat only non-starchy vegetables and legumes salads once or twice weekly.

  • Try to eat all your food within a window of 8–10 h, refraining from between-meal snacks. Emphasize mindful eating, preferably shared with others.

4. Be physical active every day

  • Commit to at least 30–60 min of daily physical exercise, alternating between aerobic, strength, flexibility, and balance exercises.

  • Minimize sitting time, and move as often as possible integrating enjoyable, friend-oriented activities into your daily routine.

5. Avoid or limit alcohol consumption

  • If you do not drink alcohol, do not start.

  • If you choose to drink, minimize intake to prevent cancer, atrial fibrillation and heart disease.

6. Do not smoke

  • Do not use any form of tobacco, including e-cigarettes and vaping.

7. Prioritize quality sleep

  • Set a bedtime that is early enough for you to get between 7–9 h of sleep.

  • Establish a consistent sleep schedule, creating a sleep-friendly environment, and turn off electronic devices at least 30 min before bedtime.

8. Nourish and protect your mind

  • Practice stress reduction through mindful meditation and slow deep breathing.

  • Stimulate your mind daily with activities like learning new skills or engaging in artistic pursuits for enhancing cognitive function and brain health.

  • Adopt a lifelong mindset of self-awareness and personal growth, seeking new knowledge, experiences, and perspectives for intellectual and spiritual vitality, and human flourishing.

9. Cultivate friendship, altruism, and compassion

  • Nurture deep connections with family and friends through empathetic communication and forgiveness.

  • Practice daily altruism and compassion to reinforce synaptic networks of peace and eudemonia.

10. Minimize pollution exposure and connect with nature

  • Reduce exposure to pollution, including air, water, and noise.

  • Immerse yourself in nature as often as possible. Exercising in unpolluted environments, particularly in parks and wooded areas, confers cardioprotective and psychological benefits.

1. Reduce waist circumference and increase muscle mass

  • Take action to reduce your waistline with endurance exercise and moderate calorie restriction, ensuring you consume the right amount of nutrient-rich calories for optimal functioning.

  • Increase or maintain skeletal muscle mass with resistance exercise.

2. Adhere to a minimally processed Mediterranean-like diet

  • Eat a wide range of vegetables, whole grains, legumes, nuts, and fruits. Avoid refined carbs.

  • Eat mostly proteins from plants (legumes, nuts, and whole grains), alongside fish, seafood, and low-fat dairy; if opting for meat and poultry, choose lean cuts on occasional basis, and avoid processed meat.

  • Avoid ultra-processed foods and beverages, rich in ‘empty’ calories, sugars, and unhealthy fats.

  • Choose and prepare foods with little salt; use iodized salt to promote thyroid health.

  • Use cold-pressed extra-virgin olive oil in moderation, while abstaining from animal fats (butter, cream), tropical oils (coconut, palm) and partially hydrogenated fats.

3. Intermittent fasting and time-restricted feeding

  • If overweight, stop eating at 80% satiety; eat only non-starchy vegetables and legumes salads once or twice weekly.

  • Try to eat all your food within a window of 8–10 h, refraining from between-meal snacks. Emphasize mindful eating, preferably shared with others.

4. Be physical active every day

  • Commit to at least 30–60 min of daily physical exercise, alternating between aerobic, strength, flexibility, and balance exercises.

  • Minimize sitting time, and move as often as possible integrating enjoyable, friend-oriented activities into your daily routine.

5. Avoid or limit alcohol consumption

  • If you do not drink alcohol, do not start.

  • If you choose to drink, minimize intake to prevent cancer, atrial fibrillation and heart disease.

6. Do not smoke

  • Do not use any form of tobacco, including e-cigarettes and vaping.

7. Prioritize quality sleep

  • Set a bedtime that is early enough for you to get between 7–9 h of sleep.

  • Establish a consistent sleep schedule, creating a sleep-friendly environment, and turn off electronic devices at least 30 min before bedtime.

8. Nourish and protect your mind

  • Practice stress reduction through mindful meditation and slow deep breathing.

  • Stimulate your mind daily with activities like learning new skills or engaging in artistic pursuits for enhancing cognitive function and brain health.

  • Adopt a lifelong mindset of self-awareness and personal growth, seeking new knowledge, experiences, and perspectives for intellectual and spiritual vitality, and human flourishing.

9. Cultivate friendship, altruism, and compassion

  • Nurture deep connections with family and friends through empathetic communication and forgiveness.

  • Practice daily altruism and compassion to reinforce synaptic networks of peace and eudemonia.

10. Minimize pollution exposure and connect with nature

  • Reduce exposure to pollution, including air, water, and noise.

  • Immerse yourself in nature as often as possible. Exercising in unpolluted environments, particularly in parks and wooded areas, confers cardioprotective and psychological benefits.

Table 1
Open in new tab

Healthy longevity heart code

1. Reduce waist circumference and increase muscle mass

  • Take action to reduce your waistline with endurance exercise and moderate calorie restriction, ensuring you consume the right amount of nutrient-rich calories for optimal functioning.

  • Increase or maintain skeletal muscle mass with resistance exercise.

2. Adhere to a minimally processed Mediterranean-like diet

  • Eat a wide range of vegetables, whole grains, legumes, nuts, and fruits. Avoid refined carbs.

  • Eat mostly proteins from plants (legumes, nuts, and whole grains), alongside fish, seafood, and low-fat dairy; if opting for meat and poultry, choose lean cuts on occasional basis, and avoid processed meat.

  • Avoid ultra-processed foods and beverages, rich in ‘empty’ calories, sugars, and unhealthy fats.

  • Choose and prepare foods with little salt; use iodized salt to promote thyroid health.

  • Use cold-pressed extra-virgin olive oil in moderation, while abstaining from animal fats (butter, cream), tropical oils (coconut, palm) and partially hydrogenated fats.

3. Intermittent fasting and time-restricted feeding

  • If overweight, stop eating at 80% satiety; eat only non-starchy vegetables and legumes salads once or twice weekly.

  • Try to eat all your food within a window of 8–10 h, refraining from between-meal snacks. Emphasize mindful eating, preferably shared with others.

4. Be physical active every day

  • Commit to at least 30–60 min of daily physical exercise, alternating between aerobic, strength, flexibility, and balance exercises.

  • Minimize sitting time, and move as often as possible integrating enjoyable, friend-oriented activities into your daily routine.

5. Avoid or limit alcohol consumption

  • If you do not drink alcohol, do not start.

  • If you choose to drink, minimize intake to prevent cancer, atrial fibrillation and heart disease.

6. Do not smoke

  • Do not use any form of tobacco, including e-cigarettes and vaping.

7. Prioritize quality sleep

  • Set a bedtime that is early enough for you to get between 7–9 h of sleep.

  • Establish a consistent sleep schedule, creating a sleep-friendly environment, and turn off electronic devices at least 30 min before bedtime.

8. Nourish and protect your mind

  • Practice stress reduction through mindful meditation and slow deep breathing.

  • Stimulate your mind daily with activities like learning new skills or engaging in artistic pursuits for enhancing cognitive function and brain health.

  • Adopt a lifelong mindset of self-awareness and personal growth, seeking new knowledge, experiences, and perspectives for intellectual and spiritual vitality, and human flourishing.

9. Cultivate friendship, altruism, and compassion

  • Nurture deep connections with family and friends through empathetic communication and forgiveness.

  • Practice daily altruism and compassion to reinforce synaptic networks of peace and eudemonia.

10. Minimize pollution exposure and connect with nature

  • Reduce exposure to pollution, including air, water, and noise.

  • Immerse yourself in nature as often as possible. Exercising in unpolluted environments, particularly in parks and wooded areas, confers cardioprotective and psychological benefits.

1. Reduce waist circumference and increase muscle mass

  • Take action to reduce your waistline with endurance exercise and moderate calorie restriction, ensuring you consume the right amount of nutrient-rich calories for optimal functioning.

  • Increase or maintain skeletal muscle mass with resistance exercise.

2. Adhere to a minimally processed Mediterranean-like diet

  • Eat a wide range of vegetables, whole grains, legumes, nuts, and fruits. Avoid refined carbs.

  • Eat mostly proteins from plants (legumes, nuts, and whole grains), alongside fish, seafood, and low-fat dairy; if opting for meat and poultry, choose lean cuts on occasional basis, and avoid processed meat.

  • Avoid ultra-processed foods and beverages, rich in ‘empty’ calories, sugars, and unhealthy fats.

  • Choose and prepare foods with little salt; use iodized salt to promote thyroid health.

  • Use cold-pressed extra-virgin olive oil in moderation, while abstaining from animal fats (butter, cream), tropical oils (coconut, palm) and partially hydrogenated fats.

3. Intermittent fasting and time-restricted feeding

  • If overweight, stop eating at 80% satiety; eat only non-starchy vegetables and legumes salads once or twice weekly.

  • Try to eat all your food within a window of 8–10 h, refraining from between-meal snacks. Emphasize mindful eating, preferably shared with others.

4. Be physical active every day

  • Commit to at least 30–60 min of daily physical exercise, alternating between aerobic, strength, flexibility, and balance exercises.

  • Minimize sitting time, and move as often as possible integrating enjoyable, friend-oriented activities into your daily routine.

5. Avoid or limit alcohol consumption

  • If you do not drink alcohol, do not start.

  • If you choose to drink, minimize intake to prevent cancer, atrial fibrillation and heart disease.

6. Do not smoke

  • Do not use any form of tobacco, including e-cigarettes and vaping.

7. Prioritize quality sleep

  • Set a bedtime that is early enough for you to get between 7–9 h of sleep.

  • Establish a consistent sleep schedule, creating a sleep-friendly environment, and turn off electronic devices at least 30 min before bedtime.

8. Nourish and protect your mind

  • Practice stress reduction through mindful meditation and slow deep breathing.

  • Stimulate your mind daily with activities like learning new skills or engaging in artistic pursuits for enhancing cognitive function and brain health.

  • Adopt a lifelong mindset of self-awareness and personal growth, seeking new knowledge, experiences, and perspectives for intellectual and spiritual vitality, and human flourishing.

9. Cultivate friendship, altruism, and compassion

  • Nurture deep connections with family and friends through empathetic communication and forgiveness.

  • Practice daily altruism and compassion to reinforce synaptic networks of peace and eudemonia.

10. Minimize pollution exposure and connect with nature

  • Reduce exposure to pollution, including air, water, and noise.

  • Immerse yourself in nature as often as possible. Exercising in unpolluted environments, particularly in parks and wooded areas, confers cardioprotective and psychological benefits.

Optimization of body composition and muscle function

Prioritizing optimal body composition over mere weight control is crucial for cardiovascular health. Integrating moderate calorie restriction with regular endurance and resistance exercise training forms the cornerstone of mitigating the age-related accumulation of harmful visceral and ectopic fat, while enhancing muscle mass and function, particularly of the large metabolically active gluteofemoral muscles.1

Consumption of a predominantly plant-based Mediterranean-like diet

Optimizing diet quality while reducing ‘empty’ calorie is key for metabolic health.2 Consuming a primarily plant-centric fibre-rich diet enriched with fish and low-fat dairy products (Table 1) is foundational to improve classical and emerging risk factors via synergistic and complementary metabolic, molecular, and metagenomic mechanisms.1,3 Lower intake of saturated and trans-fatty acids, branch-chain, and sulfur amino acids, and salt, while increasing the intake of fibre, polyunsaturated omega-3 fatty acids, and essential vitamins (e.g. vitamin C, E, and B complex, folic acid, and β-carotene), minerals (e.g. potassium, magnesium, and selenium), and phytochemicals (e.g. polyphenols, terpenes, sterols, and indoles) underlies some of these beneficial effects. Supported by extensive pre-clinical, epidemiological, and randomized clinical trial data, this Mediterranean-like dietary pattern offers significant benefits for both healthy individuals and those at high-risk or with established atherosclerotic and hypertensive cardiovascular diseases.4

Intermittent fasting and time-restricted eating

For individuals fighting with obesity, alongside regular exercise and cessation of eating at 80% satiety, incorporating intermittent vegetable fasting or time-restricted eating (8- to 10-h window) on nutritionally balanced feasting days may offer complementary strategies for weight management and improved metabolic health.3

Engagement in daily physical exercise

Regular physical activity is pivotal for cardiovascular health, leading to reduced visceral adiposity and improvements in glucose metabolism, insulin sensitivity, blood pressure, and lipid profile.1 Alternating diverse exercise modalities, including aerobic, high-intensity interval training, strength, flexibility, and balance training, for at least 30–60 min daily is recommended for a comprehensive approach to enhancing physical fitness and metabolic outcomes. Incorporating regular 3- to 5-min breaks to counter prolonged sitting can further enhance insulin and lipid metabolism, reducing cardiovascular mortality independently of structured exercise training.5

Alcohol abstinence: a prudent choice for cardiovascular health

Contrary to common belief, accumulating evidence shows that alcohol is not beneficial for cardiovascular and cerebrovascular health. It elevates the risk of hypertensive heart disease, cardiomyopathy, atrial fibrillation, flutter, and stroke while promoting cognitive impairment.6 Moreover, even in small quantities, alcohol consumption can raise cancer risk due to acetaldehyde, a carcinogenic ethanol metabolite. Thus, if you do not drink, it is best not to start, and if you do, keep alcohol intake to a minimum.4

Abstinence from all forms of smoking

All forms of tobacco use, including second-hand smoking, significantly harm cardiovascular health by inducing inflammation, endothelial dysfunction, a prothrombotic state, and sympathetic nervous system activation. These factors are pivotal in the pathogenesis of atherosclerotic ischaemic heart disease, stroke, and heart failure. Remarkably, even smoking just one cigarette daily carries roughly half the risk of coronary heart disease and stroke compared with smoking 20 cigarettes daily.7 No safe level of smoking exists in relation to heart disease, stroke, cancer, dementia, and chronic respiratory diseases.

Prioritization of restorative sleep

Insufficient sleep duration and disrupted sleep patterns are emerging risk factors for the onset and progression of hypertension, atrial fibrillation, ischaemic heart disease, and dementia. Poor sleep quality contributes to chronic inflammation, insulin resistance, heightened oxidative stress, increased sympathetic activity, and disruptions in various hormonal factors, including leptin and ghrelin.8 Ensuring a bedtime for 7–9 h of sleep, maintaining a consistent sleep schedule, creating a sleep-friendly environment, and switching off electronic devices 30 min before bedtime are important strategies for promoting quality sleep and sustaining cardiovascular health.

Reduction of mental stress and promotion of emotional and spiritual well-being

Chronic mental stress and persistent negative emotions can significantly impact cardiovascular health, independent of classical risk factors. Anger, for instance, can trigger dangerous polymorphic ventricular arrhythmias. These effects are mediated through activation of the hypothalamic–pituitary–adrenal axis and autonomic nervous system, leading to elevated blood pressure, heightened platelet and immune responsiveness, and increased inflammation and oxidative stress.9 Mindfulness-based stress reduction and cognitive therapy, particularly when combined with slow breathing exercises and artistic/philosophical spiritual practices, can effectively alleviate psychological and emotional stress, anxiety, and depression and promote human flourishing.1

Foster meaningful relationships, altruism, and compassion

Robust social and family bonds are essential for emotional and mental well-being. Conversely, lack of social and emotional support, loneliness, hopelessness, and depression substantially elevate the risk of cardiovascular disease and cognitive decline. Alongside increased high-risk behaviours (e.g. excessive food and alcohol consumption and smoking), this leads to a proatherogenic state facilitated by hypercortisolaemia, impaired vagal function, reduced heart rate variability, inflammation, and increased platelet aggregation.1,9 Nurturing deep connections with family and friends through insight, empathetic communication, and forgiveness, marked by altruism and compassion, are paramount in enhancing the plasticity of well-being.

Reduce exposure to pollution

Air pollution, even at low levels of fine particulates like PM2.5, is linked to increased cardiovascular, respiratory, and cancer mortality. Exposure to PM2.5 and ozone reduces heart rate variability, activates the immune system, and heightens oxidative stress, leading to endothelial dysfunction in both the vasculature and brain.10 This exposure also amplifies arterial sensitivity to vasoconstricting agents like cortisol and catecholamines. Mitigating pollution exposure can be achieved through measures like masks, closed car windows, and air-conditioning, especially in heavily polluted environments. Physical activity in unpolluted environments, particularly parks and wooded areas, offers both cardioprotective and psychological benefits. In contrast, exercising in polluted areas may harm heart health.

Conclusions

A holistic approach to cardiovascular aging entails the assimilation of these 10 strategies into one's lifestyle. By making informed choices regarding nutrition, exercise, mental well-being, and environmental consciousness, men, women, and children can proactively promote cardiometabolic health and attenuate the aging trajectory of their cardiovascular system. These recommendations extend beyond cardiovascular health and significantly contribute to both primary and secondary prevention of various prevalent chronic diseases, all rooted in a common metabolic and molecular substrate (Figure 1). This transition is crucial for shifting our healthcare and educational systems from a focus on chronic disease management to a proactive emphasis on chronic health promotion to achieve financially sustainable, universal health coverage for all.

Systems biology of healthy longevity and well-being. This figure illustrates the interconnected systems involved in promoting metabolic health and longevity. By addressing a shared common metabolic substrate, various prevalent cardiometabolic and chronic diseases can be proactively prevented. Specific lifestyle interventions, operating on distinct yet complementary metabolic and molecular pathways, serve to hinder the accumulation of cellular, tissue, and organ damage. Moreover, these interventions play a key role in modulating the pathogenesis and prognosis of multiple chronic diseases, ultimately contributing to the extension of healthspan. BCAA, branched-chain amino acids; COPD, chronic obstructive pulmonary disease; GLUT4, glucose transporter type 4; HDL, high-density lipoprotein cholesterol; IGFBP1, insulin-like growth factor-binding protein-1; LDL, low-density lipoprotein cholesterol; MUFA, monosaturated fatty acids; NaCl, sodium chloride; PCOS, polycystic ovary syndrome; PUFA, polyunsaturated fatty acids; SCFA, short-chain fatty acids; SFA, saturated fatty acids; SHBG, sex hormone-binding globulin; TMAO, trimethylamine N-oxide.
Figure 1

Systems biology of healthy longevity and well-being. This figure illustrates the interconnected systems involved in promoting metabolic health and longevity. By addressing a shared common metabolic substrate, various prevalent cardiometabolic and chronic diseases can be proactively prevented. Specific lifestyle interventions, operating on distinct yet complementary metabolic and molecular pathways, serve to hinder the accumulation of cellular, tissue, and organ damage. Moreover, these interventions play a key role in modulating the pathogenesis and prognosis of multiple chronic diseases, ultimately contributing to the extension of healthspan. BCAA, branched-chain amino acids; COPD, chronic obstructive pulmonary disease; GLUT4, glucose transporter type 4; HDL, high-density lipoprotein cholesterol; IGFBP1, insulin-like growth factor-binding protein-1; LDL, low-density lipoprotein cholesterol; MUFA, monosaturated fatty acids; NaCl, sodium chloride; PCOS, polycystic ovary syndrome; PUFA, polyunsaturated fatty acids; SCFA, short-chain fatty acids; SFA, saturated fatty acids; SHBG, sex hormone-binding globulin; TMAO, trimethylamine N-oxide.

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Acknowledgements

L.F. is supported by grants from the Bakewell Foundation, the Australian NHMRC Investigator Grant (APP1177797), and Australian Youth and Health Foundation. S.M.T. is supported by grants from Diabetes Australia—Kellion Victory Medal Research Program—and healthy ageing. M.L.C. is supported by a grant of the Schmidt Science Fellows program.

Declarations

Disclosure of Interest

All authors declare no disclosure of interest for this contribution.

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Published by Oxford University Press on behalf of the European Society of Cardiology 2024.
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)
Issue Section:
CardioPulse
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