AJM Theme Issue: Diabetes/Metabolism
Clinical research study
Turning Back the Clock: Adopting a Healthy Lifestyle in Middle Age

https://doi.org/10.1016/j.amjmed.2006.09.020Get rights and content

Abstract

Purpose

To determine the frequency of adopting a healthy lifestyle (5 or more fruits and vegetables daily, regular exercise, BMI 18.5-29.9 kg/m2, no current smoking) in a middle-aged cohort, and determine the subsequent rates of cardiovascular disease (CVD) and mortality among those who adopt a healthy lifestyle.

Methods

We conducted a cohort study in a diverse sample of adults age 45-64 in the Atherosclerosis Risk in Communities survey. Outcomes are all-cause mortality and fatal or non-fatal cardiovascular disease.

Results

Of 15,708 participants, 1344 (8.5%) had 4 healthy lifestyle habits at the first visit, and 970 (8.4%) of the remainder had newly adopted a healthy lifestyle 6 years later. Men, African Americans, individuals with lower socioeconomic status, or a history of hypertension or diabetes were less likely to newly adopt a healthy lifestyle (all P <.05). During the following 4 years, total mortality and cardiovascular disease events were lower for new adopters (2.5% vs 4.2%, χ2 P <.01, and 11.7% vs 16.5%, χ2 P <.01 respectively) compared to individuals who did not adopt a healthy lifestyle. After adjustment, new adopters had lower all-cause mortality (OR 0.60, 95% Confidence Interval [CI], 0.39-0.92) and fewer cardiovascular disease events (OR 0.65, 95% CI, 0.39-0.92) in the next 4 years.

Conclusions

People who newly adopt a healthy lifestyle in middle-age experience a prompt benefit of lower rates of cardiovascular disease and mortality. Strategies to encourage adopting healthy lifestyles should be implemented, especially among people with hypertension, diabetes, or low socioeconomic status.

Section snippets

Study Population

The Atherosclerosis Risk in Communities Study (ARIC) is a prospective epidemiologic study of 15,792 men and women ages 45 to 64 years at enrollment in four communities across the United States that was designed to investigate the origin and progression of various atherosclerotic diseases.12 The first set of interviews and examinations (Visit 1) in which baseline information was collected were conducted from years 1987 to 1989. The full interview and exam methodology can be found on the ARIC web

Results

Initial lifestyle status could be determined for 15,708 individuals in the study, and 1344 (8.5%) engaged in all 4 healthy lifestyle factors during Visit 1 (Table 1). Participants aged 45-54 years, men, African-American, and individuals with histories of hypertension or diabetes were significantly less likely to be leading a healthy lifestyle during Visit 1. Individuals with less than college education or family annual incomes less than $35,000 (lower socioeconomic status) also were less likely

Discussion

In this study, we found that a midlife switch to a healthy lifestyle that includes a diet of at least 5 daily fruits and vegetables, exercise, maintaining a healthy weight, and not smoking results in a substantial reduction in mortality and cardiovascular disease over the subsequent 4 years. This benefit was independent of age, race, gender, socioeconomic status, a history of hypertension, hypercholesterolemia, diabetes, or previous cardiovascular disease. The study adds 3 new features to the

Acknowledgments

The Atherosclerosis Risk in Communities Study (ARIC) is conducted and supported by the NHLBI in collaboration with the ARIC Study Investigators. This manuscript was prepared using a limited access dataset obtained by the NHLBI and does not necessarily reflect the opinions or views of the ARIC Study or the NHLBI. The authors thank Vanessa Diaz, MD, MS; and Richelle Koopman, MD, MS, for their helpful suggestions and review of the manuscript.

References (28)

  • K. Esposito et al.

    Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial

    JAMA

    (2003)
  • A. Menotti et al.

    Cardiovascular risk factors and 10-year all-cause mortality in elderly European male populations: the FINE study

    Eur Heart J

    (2001)
  • M. Sumanen et al.

    Secondary prevention of coronary heart disease is disappointing among patients of working age

    Fam Pract

    (2004)
  • R.A. Pollitt et al.

    Evaluating the evidence for models of life course socioeconomic factors and cardiovascular outcomes: a systematic review

    BMC Public Health

    (2005)
  • Cited by (0)

    View full text