Health Conditions News

Healthy Middle Age Makes a Big Difference

by Howard LeWine, M.D.
Harvard Medical School

Avoiding certain health problems in middle age dramatically improves your lifetime chances of preventing a heart attack or stroke, a new study finds. The study included about 250,000 people. It looked at a person's lifetime risk based on their health at certain ages. Researchers put together the numbers from 18 prior studies. To gauge health, they focused on the standard factors that most strongly increase the risk of heart attack or stroke. They are smoking, high cholesterol, high blood pressure and diabetes. The study found that people with none of these risk factors at mid-life had very little chance of a heart attack or stroke in the rest of their lives. An example would be a 45-year-old male nonsmoker with ideal cholesterol and blood pressure, and no diabetes. His chance of ever having a heart attack or stroke would be 1.4%, researchers said. This compares with almost a 50-50 chance for a man who had 2 risk factors at age 45. Researchers said the study shows the great advantage to preventing these conditions with lifetime healthy habits. The New England Journal of Medicine published the study. HealthDay News wrote about it January 25.

What Is the Doctor's Reaction?

Smoking, diabetes, high blood pressure and high cholesterol -- you've heard the list before. The more of these risk factors you have, the greater your chance of having a heart attack. They also increase your risk of stroke and early death.

All of that is old news. It makes sense that if you have fewer of these risk factors, your chances of living a longer and healthier life improve.

But it's big news to show just how dramatically your health outlook improves if you avoid these risk factors. In today's New England Journal of Medicine, researchers report on just such a study. They based their findings on an extensive evaluation of 18 studies. Those studies included more than 250,000 men and women. The extra value of this report is the inclusion of blacks as well as whites.

Doctors use risk factors to estimate a person's risk of dying or having a heart attack or stroke within 10 years. This 10-year risk helps guide how urgently risk factors need to be modified. For example, the goal level of LDL (cholesterol) is lower and usually requires medicine if someone's 10-year risk is high. If it is low, diet alone is often enough.

These researchers looked at the more important lifetime disease risk of people in middle age. They focused on the risk of heart attack, stroke and other diseases related to blood vessels. They calculated the chances of developing or dying from one of these conditions. And they compared risk for people with an "ideal" profile to those with two or more risk factors.

An ideal profile means:

• Not smoking
• No diabetes
• Total cholesterol less than 180 milligrams per deciliter
• Blood pressure less than 120 systolic (the top number) and less than 80 diastolic (the bottom number)

The researchers made calculations for people ages 45, 55, 65 and 75. All of the results pointed to dramatic differences for people with ideal profiles.

The greatest difference seen was among 55-year-old women. Those with no risk factors had a nearly 20 times lower lifetime risk of heart attack than those with 2 or more risk factors. These statistics included heart attacks that cause death. For men, the risk was more than 10 times lower.

What Changes Can I Make Now?

For decades, we've known the importance of modifying the four major heart risk factors by:

• Quitting smoking
• Losing weight and exercising more if we have a higher than normal blood sugar
• Controlling high blood pressure
• Lowering cholesterol with diet and medicine if necessary

But these steps are aimed at trying to fix problems after they exist. What we learn from this study is that preventing these problems should be our goal. This means following healthy behaviors even in childhood so that risk factors do not develop in middle age.

While this is true for everyone, it is especially true for blacks. On average, blacks are more likely than whites to develop one or more of these risk factors in middle age.

What Can I Expect Looking to the Future?

Scientists have been looking for better ways to evaluate our risk of heart and blood vessel diseases. Some new tests have helped a little to better define your chance of heart attack or stroke. But based on this study and so many others, nothing comes close to topping the traditional four risk factors.

Categories: Stroke, Heart Health

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