Favorable middle-age cardiovascular health reduces costs, improves long-term outcomes

Adults who had favorable cardiovascular health in early middle age lived an average of 3.9 years longer, survived 4.5 years longer before developing a chronic illness and saved nearly $18,000 in Medicare costs compared with those with two or more risk factors at middle age, according to a longitudinal cohort study.

The researchers defined favorable cardiovascular health as having favorable levels of all major cardiovascular risk factors, including blood pressure, cholesterol, diabetes, body mass index and smoking.

Lead researcher Norrina B. Allen, MPH, PhD, of Northwestern University, and colleagues published their results online May 1 in Circulation.

“Good cardiovascular health in middle age delays the onset of many types of disease so that people live longer and spend a much smaller proportion of their lives with chronic illness,” Allen said in a news release. “Health professionals need to let young adults know that maintaining or adopting a heart-healthy lifestyle makes it more likely that you’ll live longer and still be healthy enough to do the things you love to do when you’re older.”

By 2030, an estimated 40.5 percent of the U.S. population will be living with cardiovascular disease, according to the researchers. They added that preventing the development of risk factors could help reduce the cardiovascular disease burden.

For this analysis, they evaluated 25,804 adults who participated in the Chicago Heart Association Detection Project (CHA) study. The longitudinal prospective trial enrolled men and women who were 18 to 74 years old at baseline from 1967 to 1973 and worked in the Chicago area.

The mean age was 44 years old at baseline, while 43 percent of participants were female and 90 percent were white. All of the adults were at least 65 years old by 2010.

In addition, 6 percent of participants had favorable levels of all major cardiovascular risk factors, 19 percent had at least one risk factor at elevated levels, 40 percent had one high risk factor and 35 percent had at least two high risk factors. The researchers noted that participants with favorable cardiovascular health at baseline were younger, more likely to be female and had a higher education level.

They found that being in favorable cardiovascular health significantly delayed the incidence of major all-cause morbidity by an average of 4.5 years and cardiovascular morbidity by 6.9 years compared with adults with two or more high risk factors. They added that cardiovascular health at younger ages was significantly associated with absolute and relative compression of cardiovascular morbidity at older ages. Men experienced a greater benefit than women.

Meanwhile, CMS spent a median of more than $5,000 fewer dollars per year for healthcare from age 65 on for adults with favorable cardiovascular health.

“This study represents some of the first findings that favorable cardiovascular health in middle age is associated with older age at incidence of major morbidity and lower cumulative levels of disability, as well as with healthy, not just greater, longevity,” the researchers wrote. “Our findings on the benefits of being in favorable cardiovascular health at younger ages considerably extend the observations of prior research demonstrating a reduction in the incidence of specific [cardiovascular diseases], as well as cancer, depression, and higher cognitive functioning, along with other favorable outcomes. We found that an increasing burden of cardiovascular risk factors was associated with a longer period of life lived with morbidity in a dose-dependent fashion, thus suggesting that any improvements in cardiovascular health will likely translate to reductions in morbidity in older age.”

The researchers mentioned a few limitations of the study, including that they only had one measure of cardiovascular risk factors at baseline and could not account for changes in risk factor levels or treatments over time. They also did not have information on other socioeconomic status factors besides income. In addition, they only examined adults with fee-for-service Medicare coverage, and they did not have outcomes before age 65.

“Our findings have important implications for prevention,” the researchers wrote. “At the individual level, living a longer and healthier life free of major morbidity can provide strong motivation to maintain and improve cardiovascular health across the life span. At the population and healthcare system levels, these findings directly support the need to improve prevention efforts and to target them earlier in life, before the development of adverse risk factor levels (ie, primordial prevention). Our data suggest that the resultant reductions in morbidity could translate to large savings in healthcare spending at the national level.”