Favorable cardiovascular health habits in middle age equate to longer life, fewer health care costs

Developing favorable CV health habits in early middle age results in a longer and overall healthier life with fewer chronic illnesses, as well as fewer health care costs, according to the results of a 40-year study published in Circulation.

“Good [CV] health in middle age delays the onset of many types of disease so that people can live longer and spend much smaller proportion of their lives with chronic illness,” Norrina Allen, PhD, MPH, assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine, said in a press release. “Health professionals need to let young adults know that maintaining or adopting a heart-healthy lifestyle makes it more likely that you’ll live longer and still be healthy enough to do the things you love to do when you’re older.”

CV health in midlife

To examine the impact of CV health in middle age, the investigators for the CHA study took baseline measurements of BP, cholesterol, diabetes, BMI and smoking of 39,522 men and women aged 18 to 74 years.

The participants were divided into four cohorts based on CV health — favorable levels of all factors (6%), no high risk factors but at least one elevated risk factor (19%), one high risk factor (40%) and at least two high risk factors (35%) — and were observed from 1967 to 1973.

Morbidity in older age was determined using linked Medicare and National Death Index data collected between 1984 and 2010.

ICD-9 codes for each follow-up year were used to calculate a participant’s all-cause morbidity score and CV morbidity score.

A total of 25,804 participants (65% of original CHA group) older than 65 years by 2010 were included in the analysis (43% women; 90% white; mean age at baseline, 44 years).

Survival was extended by approximately 4 years due to favorable CV health at an earlier age, according to the researchers.

The onset of all-cause and CV morbidity in those with favorable CV health was postponed by 4.5 and 7 years, respectively, which resulted in compression of morbidity in absolute and relative terms. There were also lower cumulative and annual costs for health care in those with favorable CV health (P < .001) during medical eligibility, Allen and colleagues wrote.

Economic sense

In a related editorial, Khurram Nasir, MD, MPH, of the Center for Healthcare Advancement and Outcomes at Baptist Health South Florida in Coral Gables, Florida, and colleagues wrote that the researchers “introduce a way to provide robust, real-world cost estimates that can allow policymakers to deliberate on the potential benefits of ideal [CV health] in terms of reduced or delayed health care consumption. ... Living longer in good [CV] health makes economic sense, and without a doubt, upstream prevention and wellness is a pragmatic societal investment.”

Allen said in the release that the data are grim for adults aged 40 to 59 years without ideal health factors, but there is still time for those individuals to better their CV health.

“The small proportion of participants with favorable levels in their 40s is call for all of us to maintain or adopt a healthy lifestyle earlier in life,” she said. “But risk factors and their effects accumulate over time, so even if you have risks, it’s never too late to reduce their impact on your later health by exercising, eating right, and treating your high [BP], cholesterol and diabetes.” – by Dave Quaile

Disclosure: The researchers report no relevant financial disclosures. Nasir reports serving on an advisory board for Quest Diagnostics and consulting for Regeneron. Another editorial author reports receiving institutional research grants from Johnson & Johnson and Medtronic, serving on an advisory board for UnitedHealth and founding Hugo.