Heart-Healthy Lifestyle in Young Adults Impacts Daily Living Decades Later
The number of risk factors for cardiovascular disease (CVD) that a person has in young adulthood and early middle age predicts their ability to carry out their activities of daily living after age 65, according to a decades-long study that followed workers and their health through their lifetimes.
“[H]ealthy lifestyle is the central message,” said the study’s lead author Thanh-Huyen T. Vu, MD, PhD (Northwestern University, Chicago, IL), in an email. “Society and healthcare providers should promote healthy lifestyle, and people should adopt and maintain a healthy lifestyle to avoid the development of CVD risk factors and functional disability.”
Beginning in 1967 and ending in 1973, the Chicago Heart Association Detection Project in Industry enrolled employed men and women between the ages of 29 and 68 years old with no history of MI or ECG abnormalities.
Each participant was assigned one of four baseline cardiovascular risk profiles ranging from the lowest risk, which was defined as optimal level of all major CVD risk factors (blood pressure ≤ 120/80 mm Hg, total cholesterol < 200 mg/dL, no prescription for antihypertensive or cholesterol-lowering medication, BMI < 25 kg/m2, and no diabetes or current smoking), to the highest risk (two or more of the following: high systolic or diastolic blood pressure, elevated cholesterol, taking medications for high blood pressure or cholesterol, having diabetes or BMI >30 kg/m2, or being a current smoker).
The researchers reached out to participants via questionnaires at various intervals, with the 32-year follow-up of 10,689 survivors—conducted in 2003—being the focus of the current report. In all, details on 6,014 responders to the 32-year survey were analyzed.
At the time of follow-up, the average age of participants was 76.6 years. The researchers found that the number of CVD risk factors a person had at baseline correlated strongly with the physical limitations they experienced as they aged.
The fewer risk factors they had, the less likely they were to have difficulties with self-care activities such as bathing, dressing, toileting, transfer, continence, and feeding. The same was true for other activities required for living independently such as shopping, laundry, light housework, managing money, preparing food, managing medication, using a telephone, and getting around outdoors. Risk for functional difficulties increased proportionally with increasing number of risk factors at baseline. No differences were seen between men and women, or when accounting for factors such as age, race, and length of education. Rather, the primary drivers of later functional status were BMI, smoking status, and blood pressure levels at baseline.
A Different Message to Promote Healthy People
In a previous study of the same cohort, the researchers had shown that people with low CVD risk at young/middle age had lower mortality risk as they aged. Focusing on functional ability in the current study provides additional reasons for patients to do what they can to avoid and prevent critical risk factors from developing in youth, Vu said, noting that CVD and non-CVD-related health outcomes may share some common causes and may be responsive to the same preventive strategies.
Furthermore, he said, the findings have implications for healthcare providers, who can share the information with their patients and use it to promote a healthy lifestyle in the context of preserving independence and quality of life as they age, as opposed to focusing only on mortality risk.
“It not only supports the goal to improve the cardiovascular health of all Americans by 20%, as indicated in the 2020 Strategic Impact Goals of the American Heart Association to prevent or delay the onset of CVD later in life, but also provides strong support to help achieve the goals of Healthy People 2020.” The latter is a national effort launched in 2010 by the US Department of Health and Human Services aimed at ensuring high-quality, long lives free of preventable disease and disability.
- Vu reports no relevant conflicts of interest.
Vu T-HT, Lloyd-Jones DM, Liu K, et al. Optimal levels of all major cardiovascular risk factors in younger age and functional disability in older age: The Chicago Heart Association detection project in industry 32-year follow-up health survey. Circ Cardiovasc Qual Outcomes. 2016;Epub ahead of print.