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  • Review Article
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Interventions to promote cardiometabolic health and slow cardiovascular ageing

Nature Reviews Cardiology volume 15, pages 566–577 (2018)Cite this article

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Abstract

Cardiovascular ageing and the atherosclerotic process begin very early in life, most likely in utero. They progress over decades of exposure to suboptimal or abnormal metabolic and hormonal risk factors, eventually culminating in very common, costly, and mostly preventable target-organ pathologies, including coronary heart disease, stroke, heart failure, aortic aneurysm, peripheral artery disease, and vascular dementia. In this Review, we discuss findings from preclinical and clinical studies showing that calorie restriction (CR), intermittent fasting, and adjusted diurnal rhythm of feeding, with adequate intake of specific macronutrients and micronutrients, are powerful interventions not only for the prevention of cardiovascular disease but also for slowing the accumulation of molecular damage leading to cardiometabolic dysfunction. Furthermore, we discuss the mechanisms through which a number of other nondietary interventions, such as regular physical activity, mindfulness-based stress-reduction exercises, and some CR-mimetic drugs that target pro-ageing pathways, can potentiate the beneficial effects of a healthy diet in promoting cardiometabolic health.

Key points

  • Cardiovascular ageing is a biological phenomenon caused by the accumulation over time of damage at the cellular, tissue, and organismal level leading to a progressive decline in function and structure.

  • Unhealthy lifestyle practices (such as poor nutrition, sedentary lifestyle, mental stress, smoking, and pollution) drastically increase the accrual of cellular and tissue damage, leading to cardiovascular disease.

  • Calorie restriction, intermittent fasting, and adjusted diurnal rhythm of feeding are powerful interventions for the prevention of cardiovascular dysfunction and cardiovascular disease.

  • Lowered intake of protein, specific amino acids, and saturated fatty acids (typical of the Mediterranean diet) and nutritional modulation of the gut microbiome can have additional cardioprotective roles.

  • Regular endurance and resistance exercise, mindfulness-based stress reduction programmes, and some calorie-restriction mimetic medications can potentiate the beneficial effects of a healthy diet.

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Fig. 1: Unhealthy lifestyles and disease risk.
Fig. 2: Effects of calorie restriction.
Fig. 3: Effects of diet and exercise on cellular damage.
Fig. 4: Calorie restriction, but not endurance exercise, increases maximal lifespan in rats.

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Acknowledgements

L.F. is supported by grants from the Bakewell Foundation, the Longer Life Foundation (an RGA/Washington University Partnership), the National Center for Research Resources (UL1 RR024992), and the Italian Federation of Sport Medicine (FMSI). The author apologizes for the omission of relevant work owing to space constraints.

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  1. Division of Geriatrics and Nutritional Science, Washington University, St. Louis, MO, USA

    Luigi Fontana

  2. Department of Clinical and Experimental Sciences, Brescia University Medical School, Brescia, Italy

    Luigi Fontana

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Fontana, L. Interventions to promote cardiometabolic health and slow cardiovascular ageing. Nat Rev Cardiol 15, 566–577 (2018). https://doi.org/10.1038/s41569-018-0026-8

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