20-Year trend of high prevalence of zero coronary artery calcium in beach cities of Southern California: A blue zone?

Abstract

Background Blue zones are longevity hotspots around the world characterized by highest concentrations of healthy centenarians. Certified blue zone communities are designed by implementation of environmental and policy changes that promote healthy behaviors. Objective To examine the trends of prevalence of zero CAC, a marker of ideal cardiovascular and overall health status and burden of cardiovascular risk factors in Beach Cities/certified blue zones of Southern California and rest of California. Methods This is a population-based cohort study of persons aged 50 years or older in California, who underwent CAC screening between 2000 and 2019. A total of 3864 participants from Beach Cities of Southern California were identified by Zip Codes and compared with 35,537 participants from rest of California. We compared trends of prevalence of zero CAC and cardiovascular risk factors between the two groups, in 5-year intervals. Results Among 39,401 participants (mean age, 58.1 years; 36% women), 13,374 (34%) had zero CAC. The prevalence of CAC ​= ​0 was significantly higher in Beach Cities compared to the rest of California (p ​< ​0.001). Across the study period, the prevalence of cardiac risk factors including obesity, smoking, diabetes and hypertension remain significantly lower in Beach Cities. (p ​< ​0.001) Conclusions This study, shows for the first time, that higher prevalence of zero CAC in Beach Cities of California, adds validity to excellent prognosis and longevity in these areas. The impact of policy implementation and environmental changes on lifestyle patterns, cardiovascular health and healthy ageing needs to be evaluated.

The Viability of Implementing Blue Zone Practices Within the United States

“…The Blue Zones Project has shown benefits at the population level, including a 30% increase in physical activity in Albert Lea, Minnesota, a 14% decrease in obesity rates and a 30% decrease in smoking in the Beach Cities of Los Angeles, California (The Blue Zones, 2022). Focusing specifically on the Health Districts in California, through the implementation of community-based public health initiatives focused on well-being and cardiovascular disease prevention, the Beach Cities of Los Angeles have been recently classified as a "certified Blue Zone community" (S. Lakshmanan et al, 2020). The Beach Cities' transformation into a "certified Blue Zone community" has also been largely attributed to improvements in environmental conditions and alterations in lifestyle patterns similar to those seen in Blue Zones around the globe (S. Lakshmanan et al, 2020).…”

“…Focusing specifically on the Health Districts in California, through the implementation of community-based public health initiatives focused on well-being and cardiovascular disease prevention, the Beach Cities of Los Angeles have been recently classified as a "certified Blue Zone community" (S. Lakshmanan et al, 2020). The Beach Cities' transformation into a "certified Blue Zone community" has also been largely attributed to improvements in environmental conditions and alterations in lifestyle patterns similar to those seen in Blue Zones around the globe (S. Lakshmanan et al, 2020). The Blue Zones Project has had great success in implementation and proven the effectiveness of creating change revolving around the built environment.…”

Preventing Obesity—It Is Time for Multiple Policy Strategies

“…The project reports significantly reduced obesity and cardiovascular risk factors among people in the intervention cities compared with those in California as a whole. 9 However preliminary these studies may be, they suggest that multiple-policy approaches are well worth consideration. Widespread policy efforts to reduce intake of ultraprocessed foods through a combination of taxes, warning labels, marketing and portion-size restrictions, dietary guidelines, and media education campaigns, along with policies for subsidizing healthier foods and promoting greater physical activity, should be tried; they may produce meaningful effects.…”

“…Since 2012, Blue Zones has engaged with city planners in several Southern California coastal towns to establish smoking bans, make streets walkable and bike friendly, increase access to healthier food in restaurants, establish education programs in grocery stores, and promote social support for these efforts. The project reports significantly reduced obesity and cardiovascular risk factors among people in the intervention cities compared with those in California as a whole …”

Diet and longevity in the Blue Zones: A set-and-forget issue?

“…The four long-lived populations, identified around the world so far reside in: (i) Okinawa, the southernmost island of Japan; (ii) the island of Ikaria in Greece; (iii) an area that includes the mountainous part of Sardinia, Italy; and (iv) an area corresponding to the Nicoya Peninsula in Costa Rica [6][7][8][9][10]. Additional populations with a high prevalence of long-lived individuals have been claimed to deserve the Blue Zone status [11,12], but no rigorous age validation processes using death certificates and social security records have been conducted in these areas as in the four BZs mentioned above. Analysis of the dietary habits of these communities has been carried out in a nonsystematic and incomplete way so far and thus it presents major challenges.…”