Begin early to ward off heart disease, study urges

Reduce your risk factors to one or none before you hit 50, an expert says.
WASHINGTON POST
It's a truism that healthy aging begins long before you hit old age. Now a large study has confirmed that and suggested a new approach for those hoping to live a long and healthy life: Aim to reach age 50 with as few risk factors for heart disease and stroke as possible.
Not smoking, maintaining a healthy weight and warding off diabetes, high blood pressure and high cholesterol may drastically reduce your risk of cardiovascular disease and add 10 years to your life, the study reports.
The "prevention of heart disease needs to begin very early in life because by middle age, most of the risk factors are already established," said Howard Cooper, associate director of the coronary care unit at Washington Hospital Center. "We need to focus on young adults, even teens" and "create a lifestyle that will prevent or keep [them] from developing" cardiovascular disease, which is the country's leading cause of serious illness and death.
Heart study
The findings, published in the journal Circulation this month, are the latest results from the Framingham Heart Study, which began in 1948 and is run by the National Heart, Lung, and Blood Institute. The observational study, which did not detail specific treatments, "supports the notion that aggressively treating cardiovascular disease risk factors" is the smartest approach, said Chris O'Donnell, associate director of the Framingham Heart Study.
Estimates of lifetime risk for cardiovascular disease, presented in the study, have not been calculated in previous research. "Until today all we've talked about is risk in increments of time" -- such as five or 10 years out, making the results of this study particularly useful, said Mandeep Mehra, head of cardiology at the University of Maryland School of Medicine.
The results -- based on findings from 3,564 men and 4,362 women -- are "really very tangible data that strongly support the need for modifying one's risk as early as possible," O'Donnell said.
Dramatic differences
Researchers found dramatic differences in cardiovascular disease risk and length of life between participants who reached age 50 with two or more risk factors, and those who reached that age with "optimal" -- that is, fewer than two -- risk factors. Lifetime risk of developing cardiovascular disease among 50-year-old men with two major risk factors was almost 69 percent, compared with 5 percent in those with fewer; for women, those with two or more risk factors had a 50 percent lifetime risk, compared with 8 percent in those with fewer. Those with minimal risk lived longer, too -- about 10 years longer than those with two or more factors.
Researchers included participants age 50 and older who, during initial exams, were free from cardiovascular disease. Overall, their lifetime risk of developing cardiovascular disease was 51.7 percent for men and 39.2 percent for women. Men with two or more risk factors at age 50 were found to live to a median age of 78 -- compared with 89 in those with fewer risk factors; women with two or more risk factors survived to age 81, compared with 89 in those with fewer risk factors.
Best chance at long life
Addressing risk factors well before reaching age 50, say heart specialists, offers the best chance of a long life. Still, very few of the study's participants had less than two risk factors: just 3 percent of men and 4.5 percent of women -- figures that are probably representative of the larger American population, experts said.
Reducing risk factors to one or none is "very achievable," said the study's lead author, Donald Lloyd-Jones, assistant professor of preventive medicine and cardiology at the Northwestern University School of Medicine. "It's just that typically we don't achieve them," he said. Exercising, maintaining a healthy weight and diet, and not smoking may make a difference not just in life span and risk of disease, but also in long-term quality of life measures, such as mobility and pain levels, he said.
While heredity plays a role in risk factors like high blood pressure and high cholesterol, said Cooper, "a lot of [risk] is environmental and can be prevented."
When risks run in the family, Lloyd-Jones advised, it's important to see your doctor regularly and have risk levels monitored "so that problems are identified" early and medication can be prescribed, if needed. Taking medication to control blood pressure and cholesterol will reduce risk -- but not to the level of someone who never had such health problems, he said.
Also, focus "on maintaining a stable weight. ... Most importantly, keep your calorie intake down," recommends Lloyd-Jones.
Especially weight
Mehra seconded paying particular attention to weight. "Cessation of smoking and maintenance of body weight are the two most readily modifiable risk factors," he said. "If you can keep your weight down, your cholesterol will come down. And if you can keep your weight down, [your] risk of diabetes comes down as well."
Cooper agreed that a "healthy diet and adequate exercise" are key to warding off high blood pressure, diabetes and high cholesterol. "Eliminating the sedentary lifestyle that many Americans" are accustomed to "can add many years of healthy living to your life," he said.