Something Subtle About Death

A revered senior colleague once said to me on my birthday, “Aging beats the alternative.” As the proportion of older adults among the world’s populations continues to increase, health assessment in “middle age” becomes increasingly important. Present guidelines from the American Heart Association with the American College of Cardiology recommend a global assessment of risk to prevent or delay the onset of chronic disease.1,2 The assessment, though global, is primarily focused on evaluations of systemic vasculature and associated risks for cardiovascular morbidity and mortality. Preventive measures entail many items typically addressed in this journal: education for a healthy lifestyle and routine physician visits to check systemic blood pressure, calculate body-mass index, measure waist/hip ratio, and perform laboratory testing with a fasting lipid panel.1,2 Each of these elements is linked to prognosis for long-term cardiovascular health, including isolated systolic hypertension.3–6 Prevention of ischemic and nonischemic complications associated with systemic hypertension through lifestyle interventions and the administration of antihypertensive therapeutics available for oral everyday use has improved cardiovascular health, reducing early morbidity and mortality.3–5Article see p 2663 These gains have been based on the ease and reproducibility of measurement of systemic blood pressure by healthcare providers through techniques first reported over a little more than 100 years ago. During this past century, evaluation of an important “loop” in circulation, the pulmonary vasculature, has played no role in preventive medicine. The obvious reason is that no noninvasive equivalent to sphygmomanometry and its digital successors has been available for pulmonary vasculature pressures. Invasive cardiac catheterization is still the gold standard.In the current issue of Circulation , Lam and colleagues report initial findings of a massive effort to use echocardiographic measurements of pulmonary artery systolic pressure (PASP) to begin to make up for the lost time relative to the …