If there's one thing your internist locks in on, it's the cardiovascular system; after all, heart attack and stroke are, respectively, the nation's first and third leading causes of death. But your doc may be missing an important piece of the puzzle, which is not just whether your arteries are clogged, but how they're aging. Even healthy, plaque-free arteries lose elasticity over time. Studies on physically active indigenous people have shown arteries that are mostly clean yet can be nearly as inflexible as those of a middle-aged American couch potato. This natural stiffening causes blood pressure to creep up, though often not enough for a doctor to label it hypertension.
What's happening? Over time, the elastin and collagen fibers in the arteries begin to give out.
The elastin simply wears away, and the collagen, which provides strength and structure, gets gummed up by an increasing amount of sugar molecules. Consequently, "arterial stiffness" has become a prime biomarker in the aging field. And even though the condition increases with the years no matter what you do, it's still an excellent predictor of health — when you eat and exercise properly and don't let chronic stress drive up blood pressure, you lose flexibility more slowly.
Sebastian Conti knows this well. When the 36-year-old Houston-based sales manager first went to see Raffaele three years ago, Conti had been running, cycling, and lifting weights regularly and was in the best shape of his life. He had, according to Raffaele's tests, the arteries of a 20-year-old.
But a year later, Conti's workload mushroomed. He was spending a third of his time on the road, wining and dining clients, and a follow-up test revealed the arteries of a 31-year-old. Not so bad, but the trajectory was clear. "Outwardly I didn't look different, and I was still performing OK in workouts," Conti says. "But that number allowed me to see the cumulative damage I was doing to myself."
To understand that damage, it helps to visualize it. When your pipes grow rigid, they lose the ability to cushion the flow of blood as it comes coursing out of your heart. The result? Blood pressure rises, forcing the heart to work harder to push blood through the arteries. Over time, this weakens the heart muscle, potentially paving the way for future heart failure. Meanwhile, the kidneys and the brain suffer collateral damage. Higher blood pressure in the small blood vessels that surround the kidneys interferes with their ability to remove toxins from the blood. (The worst-case scenario is end-stage renal disease.) In the brain, capillaries under pressure can simply blow out, cutting off oxygen flow and setting the stage for cognitive decline that can become obvious by your sixties and seventies. Last and most deadly, stiff arteries, in tandem with plaque blockages, are an open invitation for heart attack and stroke.
All of which explains why your doctor assiduously takes your blood pressure. The problem is, he uses a cuff that measures only the pressure in the small brachial artery below the elbow, and he takes only two readings — the highest pressure, when the heart squeezes the blood out of its chamber (systolic pressure), and the lowest pressure, when the heart relaxes and refills with blood (diastolic pressure). That method is more accurate than taking your pulse with your finger, but it still doesn't tell you much about how your blood is flowing through your whole body. The best measure of that, and how well your entire cardiovascular system is aging, is arterial stiffness.
A new technology called pulse-wave analysis gives us a way to assess the arteries thoroughly. A doctor puts a stylus against the artery at your elbow, which gauges the pressure wave that blood creates as it circulates through the body. (Think of an avalanche and the blast of air that hits you before the snow.) It's an early-warning system. The faster that pressure wave travels down the body and bounces back to the heart, the stiffer the arteries. A worrying number from this test can show up years before your systolic blood pressure creeps up high enough to cause your internist's eyebrows to raise.
Conti intends to stay far away from that fate. By dialing back indulgences when he travels and better planning his meals and workouts when he's at home, he's been able to improve his Cardio Age to 27. Conti says, "People usually don't make changes until somebody shows them a number."
How to Lower Your Cardio Age
You want at least 30 minutes of medium-to high-intensity work every other day, be it a series of short intervals or one sustained push. This stimulates the production of nitric oxide in the arteries, relaxing them and allowing them to expand to improve blood flow. It also lowers blood glucose levels. That's key: High blood sugar is what gums up arteries.
"A lot of people with mild hypertension are in a chronically anxious state of stress," Raffaele says. You can combat that with breath. When you feel stressed, take deep, long breaths; this signals the nervous system to slow heart rate by 10 to 15 beats a minute, and it essentially assures the body that everything is OK.
Game Your Diet
Leafy greens and beets contain the nitrates that can help relax arteries. Arugula is tops in the nitrates department, romaine not so much. Supplementing with 300 milligrams of magnesium is another good way to tackle hypertension. I was so appalled by my original Cardio Age result that for a second test, I dosed myself with beet juice and magnesium, which drove my score below my actual age. Call it cheating, but I plan to cheat this way daily, thereby keeping my blood pressure down for the rest of my life.
Here is your guide to assessing — and slowing — everything from your cognitive age to your metabolic decline.