Cardiovascular Aging: Why Focused Research Matters

1. The demographic imperative

Americans are living longer, and cardiovascular disease follows them into advanced age. More than three-quarters of adults aged sixty to seventy-nine already live with cardiovascular disease, and prevalence climbs above eighty-five percent after age eighty. Nearly half of all adults in the United States, about one hundred twenty-eight million people, experience some form of cardiovascular disease today.

2. A ballooning economic load

Direct health-care spending and productivity losses linked to cardiovascular disease already exceed four hundred billion dollars each year. Forecasts suggest annual costs could almost quadruple by the year two thousand fifty as the population ages. Older adults, especially those older than eighty, will bear most of that expense.

3. Evidence gaps in older adults

Randomized trials have historically under-represented patients older than seventy-five or those with multiple chronic conditions and frailty. Several landmark studies have shown that results in younger cohorts do not always translate to older adults. Trials of coronary revascularization, transcatheter valve therapies, and comprehensive geriatric assessment all demonstrate that evidence remains thin for interventions that now dominate practice in late life.

4. HeartWise Laboratory: closing the gap

The HeartWise Laboratory exists to fill these gaps. The group is led by my friend Dr. Michael Nanna , an interventional cardiologist and outcomes researcher and myself. The team integrates geriatric medicine, cardiovascular medicine, data science, and patient advocacy to study the biology of aging and care delivery. It is a collaborative effort between Yale University and the Cleveland Clinic!

Research Pillars

5. Pragmatic clinical trials focused on function and quality of life

The Live Better trial, funded by the National Institutes of Health, randomizes older adults with stable angina to beta blockers or calcium channel blockers. The study measures not only ischemic outcomes but also daily function, symptoms, and caregiver burden. By treating quality of life as a primary outcome, the study aligns evidence with what matters most to many older adults.

6. High-resolution observational analytics

HeartWise curates longitudinal data sets linking electronic health records, Medicare claims, and geriatric assessments to study multiple chronic conditions, polypharmacy, and physiologic reserve. The goal is to build competing risk models that capture death, disability, and hospitalization simultaneously, outcomes more relevant to people in their eighth and ninth decades of life.

7. Shared decision-making prototypes

Through a pilot that embeds decision aids in clinic visits and catheterization laboratory consultations, investigators test whether visual risk tools and preference-driven conversations can improve treatment alignment and satisfaction for older adults and their caregivers.

8. Frailty, geriatric syndromes, and intervention outcomes

Systematic reviews show that frailty nearly doubles the risk of adverse events after percutaneous coronary intervention and cardiac resynchronization therapy. HeartWise studies combine gait speed, grip strength, and inflammatory biomarkers with imaging and hemodynamics to refine risk prediction and tailor care around invasive procedures.

9. Biomarker and proteomic discovery

Building on support from the National Institutes of Health, the laboratory collects plasma proteomes and metabolomes from older adults undergoing structural and coronary interventions. The aim is to identify protein clusters that signal vulnerability to adverse remodeling, cognitive decline, or hospitalization. These observations now power an ancillary study to the Live Better trial.

10. Digital health and artificial intelligence

Collaborators apply machine-learning pipelines to echocardiography, computed tomography, and wearable data sets to stratify risk and guide therapy. Current surveys of artificial intelligence in image-based cardiovascular analysis highlight both promise and the need for rigorous validation, especially when applied to lifetime risk prediction.People Behind the Program

11. Leadership

• Michael Nanna, MD, MHS, coronary interventionist focusing on risk prediction and shared decision-making in multimorbid older patients

• Abdulla A. Damluji, MD, PhD, MBA – interventional and structural cardiologist with expertise in frailty, clinical outcomes, multisystem dysrefulation, and cardiovascular disease.

12. Senior collaborators

• Ardeshir Z. Hashmi MD MBA FACP FNAP AGSF – geriatrician and leader at Cleveland Clinic

• Oliver Glen Ancheta, DO, MPH - geriatrician and expert on aging-risks in the older adult populations.

• Nishok Karthikeyan, MD - geriatrician and experit on age-associated risks.

• Jennifer Frampton, DO, MPH – clinician-investigator and interventional cardiologist (CHIP/CTO operator)

13. Early career scientists and trainees

HeartWise mentors a broad cohort, each contributing unique expertise: Raiza Rossi; Zafer Akman; Armin Nouri; Golsa Babapour; Naila Ijaz; Chidubem Ezenna; Kriti Kalra; Kuan Yu Chi; Laura Tycon Moreines; Pei Lun Alan Lee; Rebecca Hsieh; Yasser Jamil; Alexander Ambrosini; Joshua Vogel; Natalie Kolba; Gabriel Garcia Castro; Natasha Cigarroa; Asanish Kalyanasundaram; Dae Yong Park; Xaviar Mike Jones; Ramya Sampath; Roberto Lapetina Arroyo; Abdelrahman Abushouk; Santiago Callegari; Katie Stoehr; Emily Fishman; Mohammad Mouslmani; Shridar Mangalesh; Mkrishna, Mirnal.

Why This Work Matters

14. Aligning interventions with what older adults value

Older adults judge success by preserved independence, cognition, and symptom relief rather than by angiographic metrics alone. HeartWise tests therapies against those benchmarks, producing data that clinicians can use in everyday counseling.

15. Informing policy and payment

High-quality evidence on functional outcomes can guide coverage decisions, bundled payments, and quality metrics that reward patient-centered care instead of procedure volume. Such influence could temper the projected trajectory of cardiovascular disease costs.

16. Training the next generation

By embedding fellows and residents in aging research, HeartWise builds a workforce fluent in both cardiovascular therapeutics and geroscience. These clinicians will shepherd future innovations such as genome editing, cell therapy, or digital biomarkers through an aging lens.

17. Catalyzing global collaboration

The laboratory network spans the Cleveland Clinic, Yale University, and partner sites across the Americas, Europe, and Asia. Shared protocols and open-source code allow replication and accelerate discovery, addressing an international need for age-specific evidence.

18. Delivering near-term clinical tools

Risk calculators that integrate frailty, proteomics, and patient-reported outcomes can enter electronic records and bedside rounding notes within years instead of decades. These tools improve decision speed and precision.

19. Speaking for an often silent majority

When trials omit older adults with multiple chronic conditions, the resulting guidelines may inadvertently disadvantage them. HeartWise gives this group a voice in study design, outcome selection, and dissemination, reshaping how cardiology defines success.

20. A call to action

Clinicians, researchers, foundations, and policymakers share responsibility for a future in which longer life means healthier life. Collaboration with HeartWise through data sharing or philanthropic support advances that goal and brings rigorous patient-centered science to the fastest-growing segment of our population.

In conclusion, cardiovascular aging research is not a niche pursuit; it sits at the crossroads where cardiology meets public health, economics, and human dignity. HeartWise Laboratory generates the data and trains the people who will help older adults live, quite literally, better.

Please visit our website for more details: https://www.heartwiselab.com/our-team