Adopting a Healthy Lifestyle in Middle Age Reduces Later Mortality and Cardiovascular Disease

July 10, 2007 — Middle-aged patients who switch to a healthy lifestyle that includes a diet with a daily intake of at least 5 fruits and vegetables, exercise, and other factors have reduced mortality and cardiovascular disease (CVD) during the next 4 years, according to the results of a study published in the July issue of The American Journal of Medicine.
"Despite the well known benefits of having a lifestyle that includes exercise, eating a diet high in fruits and vegetables, maintaining a healthy weight, and not smoking, only a small proportion of adults follow this healthy lifestyle pattern," write Dana E. King, MD, MS, from the Medical University of South Carolina in Charleston, and colleagues. "Further characterization of individuals who adopt a healthy lifestyle in middle-age, and determining the extent of the health benefit would be extremely helpful in formulating appropriate lifestyle advice for such individuals."
The objectives of this study were to determine the proportion of individuals who adopt a 4-element healthy lifestyle (≥ 5 fruits and vegetables daily, regular exercise, body mass index [BMI] of 18.5 - 29.9 kg/m2, no current smoking) in a middle-aged cohort and to determine the subsequent rates of CVD and mortality among those who adopt a healthy lifestyle.
The study cohort was a diverse sample of adults aged 45 to 64 years in the Atherosclerosis Risk in Communities (ARIC) survey. Outcome measures were all-cause mortality and fatal or nonfatal CVD.
Of 15,708 participants, 1344 (8.5%) had 4 healthy lifestyle habits at the first visit and 970 (8.4%) of the other participants had newly adopted a healthy lifestyle 6 years later. Factors associated with lower likelihood of adopting a healthy lifestyle were male sex, African-American race, lower socioeconomic status, and a history of hypertension or diabetes (all P < .05).
Compared with individuals who did not adopt a healthy lifestyle, those who did had lower total mortality and CVD events during the next 4 years (2.5% vs 4.2%; χ2 P < .01 and 11.7% vs 16.5%; χ2 P < .01, respectively). After adjustment, new adopters had lower all-cause mortality (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.39 - 0.92) and fewer CVD events (OR, 0.65; 95% CI, 0.39 - 0.92) in the subsequent 4 years.
"People who newly adopt a healthy lifestyle in middle-age experience a prompt benefit of lower rates of cardiovascular disease and mortality," the authors write. "Strategies to encourage adopting healthy lifestyles should be implemented, especially among people with hypertension, diabetes, or low socioeconomic status."
Study limitations include possible misclassification; lack of dietary information regarding fiber, fat, sodium, magnesium, and several other nutrients; food or exercise habits possibly changing between the visits and the outcome assessment; possibly conservative estimates of reduced CVD and mortality; and categorization being limited to black/nonblack in the ARIC study database.
"The potential public health benefit from adopting a healthier lifestyle in middle age is substantial," the authors conclude. "The current study demonstrated that adopting 4 modest healthy habits considerably lowers the risk of cardiovascular disease and mortality in relatively short-term 4-year follow up period. The findings emphasize that making the necessary changes to adhere to a healthy lifestyle is extremely worthwhile, and that middle-age is not too late to act."
The National Heart, Lung, and Blood Institute in collaboration with the ARIC Study Investigators supported this study.
Am J Med. 2007;120:598-603.