Individuals in favourable cardiovascular health in early middle age live a longer, healthier life free of all types of morbidity.
A new study suggests that people who reach middle age in good heart health can look forward to a longer, healthier life. The findings were culled from an analysis that followed nearly 26,000 US adults for 40 years.
The investigators found that people in optimal heart health in middle age lived an average of four years longer than their peers who had at least two risk factors for heart disease. In addition, the people with optimal heart health lived almost five years longer free of chronic disease – which is critical, the researchers said.
"It's not just about quantity, but also quality of life," said study leader Norrina Allen, an assistant professor of preventive medicine at Northwestern University, in Chicago.
While the findings might not startle anyone, they do give a clearer picture of how much middle-aged people stand to gain from heart-healthy habits, said Dr Harlan Krumholz, a professor of medicine at Yale School of Medicine.
"Your future self will be grateful if you pay attention to these things in middle age," said Krumholz, who co-authored an editorial published with the study.
The results are based on over 25,800 Chicago adults whose health had been tracked since the late 1960s and early 1970s. All were at least 65 years old by 2010. At the study's outset, only about 6% were in optimal cardiovascular health: That meant they had healthy blood pressure and cholesterol levels, and were normal-weight, non-smokers and free of diabetes.
In contrast, over three-quarters of the study group had at least one major risk factor for cardiovascular trouble – including high blood pressure, high cholesterol, diabetes, obesity or smoking.
Overall, the small group of people who were in optimal health aged more successfully, the researchers found, though the study couldn't prove a cause-and-effect relationship. When the healthier people did suffer heart disease or a stroke, it was seven years later, on average, compared with people who'd had two or more risk factors back in middle-age, according to the report.
The people with optimal heart health also spent a greater part of their golden years free of major diseases – including cancer, kidney disease, chronic lung disease and dementia. That, in turn, translated into lower Medicare costs: almost $18,000 less, on average, the study authors said.
"In our system, sometimes we're hesitant to invest in prevention," Krumholz said. "But actually, in the long run, prevention is economically attractive." So for society, prevention is "good policy," Krumholz said. For individuals, he added, a healthier life is invaluable.
Allen agreed. "Most of us want to be as healthy as possible throughout life," she said. "We want to still do the things we love as we grow old. To help ensure that, Allen said, people need to think about their cardiovascular health sooner rather than later. Ideally, that should start early in life – with parents instilling healthy habits in their kids, she added.
"But it's never too late to start," Allen stressed. "You can start with small changes. Replace sugar-sweetened drinks with water. Walk for 30 minutes a day," she suggested. "The potential benefits are worth it," Allen said. "Delaying major diseases by five years is huge." The fact that so few study participants were in optimal cardiovascular health is "unfortunate," Allen said. But people do not have to be in "ideal" health to benefit, she explained. In this study, people with one risk factor for cardiovascular disease fared better than those with multiple risk factors.
As for the findings on Medicare costs, Allen said the implication is straightforward: "Money spent on prevention is money well spent." But that is not limited to investments in preventive health care, she said. It can also mean schools educating kids on healthy lifestyle habits, or communities creating safe, accessible places for people to exercise, Allen said.
Abstract
Background: We examined the association of cardiovascular health at younger ages with the proportion of life lived free of morbidity, the cumulative burden of morbidity, and average healthcare costs at older ages.
Methods: The CHA study (Chicago Heart Association Detection Project in Industry) is a longitudinal cohort of employed men and women 18 to 74 years of age at baseline examination in 1967 to 1973. Baseline measurements included blood pressure, cholesterol, diabetes mellitus, body mass index, and smoking. Individuals were classified into 1 of 4 strata of cardiovascular health: favorable levels of all factors, 0 factors high but ≥1 elevated risk factors, 1 high risk factor, and ≥2 high risk factors. Linked Medicare and National Death Index data from 1984 to 2010 were used to determine morbidity in older age. An individual’s all-cause morbidity score and cardiovascular morbidity score were calculated from International Classification of Disease, Ninth Revision codes for each year of follow-up.
Results: We included 25 804 participants who became ≥65 years of age by 2010, representing 65% of all original CHA participants (43% female; 90% white; mean age, 44 years at baseline); 6% had favorable levels of all factors, 19% had ≥1 risk factors at elevated levels, 40% had 1 high risk factor, and 35% had ≥2 high risk factors. Favorable cardiovascular health at younger ages extended survival by almost 4 years and postponed the onset of all-cause and cardiovascular morbidity by 4.5 and 7 years, respectively, resulting in compression of morbidity in both absolute and relative terms. This translated to lower cumulative and annual healthcare costs for those in favorable cardiovascular health (P<0.001) during Medicare eligibility.
Conclusions: Individuals in favorable cardiovascular health in early middle age live a longer, healthier life free of all types of morbidity. These findings provide strong support for prevention efforts earlier in life aimed at preserving cardiovascular health and reducing the burden of disease in older ages.
Authors
Norrina B Allen, Lihui Zhao, Lei Liu, Martha Daviglus, Kiang Liu, James Fries, Ya-Chen Tina Shih, Daniel Garside, Thanh-Huyen Vu, Jeremiah Stamler, Donald M. Lloyd-Jones
[link url="https://consumer.healthday.com/circulatory-system-information-7/coronary-and-artery-news-356/healthy-heart-in-middle-age-delivers-big-dividends-722217.html"]HealthDay material[/link]
[link url="http://circ.ahajournals.org/content/135/18/1693"]Circulation abstract[/link]
[link url="http://circ.ahajournals.org/content/135/18/1702"]Circulation editorial[/link]