Most Americans' hearts are older than their age

Your heart may be older than you are — and that's not good. According to a new CDC Vital Signs report, three out of four U.S. adults have a predicted heart age that is older than their actual age. This means they are at higher risk for heart attacks and stroke.

“Heart age” is the calculated age of a person's cardiovascular system based on his or her risk factor profile. The risks include high blood pressure, cigarette smoking, diabetes status, and body mass index as an indicator for obesity.

This is the first study to provide population-level estimates of heart age and to highlight disparities in heart age nationwide. The report shows that heart age varies by race/ethnicity, gender, region, and other sociodemographic characteristics CDC researchers used risk factor data collected from every U.S. state and information from the Framingham Heart Study to determine that nearly 69 million adults between the ages of 30 and 74 have a heart age older than their actual age. That's about the number of people living in the 130 largest U.S. cities combined.

“Too many U.S. adults have a heart age years older than their real age, increasing their risk of heart disease and stroke,” says CDC Director Tom Frieden, M.D.  “Everybody deserves to be young — or at least not old — at heart.”

Overall, the average heart age for adult men is eight years older than their chronological age, compared to five years older for women. Although heart age exceeds chronological age for all race/ethnic groups, it is highest among African-American men and women (average of 11 years older for both). Among both U.S. men and women, excess heart age increases with age and decreases with greater education and household income.

There are geographic differences in average heart age across states. Adults in the South typically have higher heart ages. For example, Mississippi, West Virginia, Kentucky, Louisiana and Alabama have the highest percentage of adults with a heart age five years or more over their actual age, while Utah, Colorado, California, Hawaii and Massachusetts have the lowest percentage.

Social workers help health care by connecting people to resources

Medicare Part D provides help to beneficiaries struggling with the cost of prescriptions drugs, but the plan's coverage gap hits some populations harder than others, particularly African-Americans age 65 and older. Reaching, or even approaching, the gap affects access to medication and influences whether those medications are taken as prescribed.

“Don't assume that the existence of Part D means that people aren't having a difficult time affording their meds,” says Louanne Bakk, an assistant professor in the University at Buffalo School of Social Work. “There are certain groups that continue struggling with prescription drug costs regardless of this federal benefit being in place.”

Previous research has looked at the gap across the general population, but a new study by Bakk published online in the journal Social Work in Public Health is the first to examine how race and gender relate to the coverage gap.

The results have important implications for social workers who need to be mindful of the cost difficulties the gap creates and the potential resources that exist to get people through that period, according to Bakk.

Under the 2010 standard benefit, the period referenced in the study, beneficiaries went into the coverage gap when their prescription drug spending reached $2,830. At this point, they pay 100 percent of their prescription drug costs until their additional prescription drug spending brought their total to $4,550.  While the Affordable Care Act decreases the amount beneficiaries are responsible for when reaching the coverage gap, costs associated with this benefit threshold can still be problematic. 

But reaching what's known as the catastrophic limit — or, a point where out-of-pocket costs decrease significantly — rarely happens. People in the coverage gap often can't afford the full cost of their medications and stop taking them. As a result, their spending never reaches the amount required to receive the catastrophic coverage benefit.

“We've known that people in poor health or those with low incomes are more likely to stop taking their medication when they go into the gap, but as we look at this demographically, although there wasn't a significant difference between males and females, we did find that older blacks are having a much harder time affording their meds than whites, and this difference is largely driven by the coverage gap.”

Available assistance meantime isn't always easy to find.  The Low Income Subsidy Program, for instance, is available through Medicare and was signed into the law at the same time Medicare Part D was enacted, but only about 50 percent of those who qualify are using this assistance. “It's mainly a lack of awareness,” she says.

Medicare Part D is complicated, with more than 50 different enrollment options and benefits that can change annually.  Yet only 10 percent of beneficiaries are in the most cost-effective plan based on their medication needs.

“People need help because of this complexity and social workers can have a direct role in providing this help,” says Bakk.  “People who struggle can be linked to the resources they need and connected to the best plan based on their needs, making changes if necessary during the annual enrollment period in October and November.”

Bakk says that as policy discussions continue there is a critical need to recognize that some individuals are continuing to have difficulties. For those struggling with prescription drug costs, resources such as the Low Income Subsidy and Elder Pharmaceutical Insurance Coverage program are available. 

High-dose vaccine reduces pneumonia risk in elderly

High-dose influenza vaccine significantly reduced the risk of serious cardio-respiratory events possibly related to influenza in seniors ages 65 and over, when compared with the standard-dose vaccine, according to a Vanderbilt-led study published by the journal Vaccine.

The large-scale, multi-center efficacy trial was led by Keipp Talbot, M.D., MPH, assistant professor of Medicine at Vanderbilt University Medical Center, who served as coordinating investigator for the more than 100 study sites.

Known as the Fluzone High-Dose vaccine, and made by Sanofi Pasteur, the inactivated influenza vaccine contains four times the amount of antigen that is contained in the standard-dose Fluzone vaccine.

Talbot and co-authors reported today that the high-dose influenza vaccine, compared to standard-dose influenza vaccine, was associated with an 18 percent reduction in serious cardio-respiratory events possibly related to influenza overall, and a 40 percent reduction in serious pneumonia.

“The high-dose influenza vaccine not only reduces influenza but also significantly reduces the potential for pneumonia during influenza season,” Talbot says. “This is an important finding and supports the annual use of high-dose influenza vaccine in older adults.”   

In the study, nearly 32,000 adults ages 65 and over were randomly assigned to receive either Fluzone High-Dose vaccine or Fluzone vaccine, and followed for six-to-eight months post-vaccination for the occurrence of influenza and serious events.

Events were grouped into the following categories: pneumonia, asthma, chronic obstructive pulmonary disease (COPD) or bronchial events, influenza (laboratory-confirmed influenza diagnosed outside of normal study procedures), other respiratory events, coronary artery events, congestive heart failure, and cerebrovascular events.

“Influenza and pneumonia combined is the eighth leading cause of death in older adults in this country, so it is especially important that this analysis showed lower rates of serious cardio-respiratory events, most notably serious pneumonia, in the Fluzone High-Dose vaccine group compared to the Fluzone group,” says David P. Greenberg, M.D., vice president, Scientific & Medical Affairs, and chief medical officer, Sanofi Pasteur US.

“Fluzone High-Dose vaccine is the only influenza vaccine in the United States that is designed specifically to address the age-related decline of the immune system in older adults,” he says.