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Healthy Living in Middle Age

Healthy Habits in 40s Pay Off in 70s

By Chris Kaiser, Cardiology Editor, MedPage Today, Published: November 05, 2012
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston

Healthy living in middle age can add more than a decade of heart attack-free living to old age, researchers found.

The overall lifetime risk for total cardiovascular disease from ages 45 to 95 was 60% for men and 55% for women, according to John T. Wilkins, MD, of Northwestern University Feinberg School of Medicine in Chicago, and colleagues.

But those with optimal risk factor profiles at age 45 lived about 14 years longer than those with at least two major risk factors in middle age, they reported online Nov. 5 in the Journal of the American Medical Association.

Not surprising, the total cardiovascular risk for men was greater than that for women across all ages, Wilkins and colleagues said.

And despite living a life within the bounds of optimal risk factors, the lifetime risk for cardiovascular disease was still 30% or greater for both sexes.

However, staying active in middle age and meeting standards to keep risk factors low significantly improved event-free survival, researchers noted.

Although studies have chronicled lifetime risk of cardiovascular disease according to separate categories of individual risks, this is the first time that lifetime risk for total cardiovascular disease has included coronary heart disease, atherosclerotic and hemorrhagic stroke, congestive heart failure, and other cardiovascular disease death, researchers said.

Previous studies have shown that health status at middle age is prognostic of future risk. And future risk increases in a step-wise fashion with a concomitant rise in risk factors during middle age.
This study sought to quantify estimates of event-free longevity based on risk factor burden in middle and older age.

For the study, researchers pooled survival data from five National Heart, Lung, and Blood Institute-funded community-based cohorts: Framingham Heart Study, Framingham Offspring Study, Atherosclerosis Risk in Communities Study, Chicago Heart Association Detection Project in Industry Study, and Cardiovascular Health Study.

Risk factors included various degrees of hypertension and dyslipidemia, diabetes, smoking, and any combination of them.

From a lifetime risk of 30% at age 45, at age 75 the risk increased to 52% for women and 54% for men.

Having one or more risk factors shortened one's estimated life span. At ages 45, 55, and 65, those with one or at least two major risk factors could expect to have halve their chances of event-free survival.

"Thus, the maintenance of optimal risk factors through ages 45, 55, and 65 years may not guarantee a life free from total CVD, but it increases the probability that more years will be lived free of CVD," the authors concluded.

The study is limited by the potential differences in defining outcomes among the various study cohorts. Also, researchers included other risk factors such as dyslipidemia that were outside of the composite endpoint.

Funding for the study came from several sources including the National Heart, Lung, and Blood Institute; National Institute of Neurological Disorders and Stroke; National Institute on Aging; and the Dedman Family Scholar in Clinical Care endowment at UT Southwestern Medical Center.

All authors reported they had no conflicts of interest.

Primary source: Journal of the American Medical Association
Source reference:
Wilkins JT, et al "Lifetime risk and years lived free of total cardiovascular disease" JAMA 2012; 308(17): 1795-1801.

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Chris Kaiser
Cardiology Editor
Chris has written and edited for medical publications for more than 15 years. As the news editor for aUnited Business Media journal, he was awarded Best News Section. He has a B.A. from La Salle University and an M.A. from Villanova University. Chris is based outside of Philadelphia and is also involved with the theater as a writer, director, and occasional actor.

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