Cardiovascular Risk Factors for Predicting a Long Life

Abstract & Commentary

By Mary Elina Ferris, MD, Clinical Associate Professor, University of Southern California. Dr. Ferris reports no financial relationship to this field of study.

Synopsis: Participants in the Framingham Heart Study who had low levels of cardiovascular risk factors in middle age had longer overall survival and less morbidity when followed to age 85. Control of risk factors may have a major influence on reaching older age in good health.

Source: Terry DF, et al. Cardiovascular risk factors predictive for survival and morbidity-free survival in the oldest-old Framingham Heart Study participants. J Am Geriatr Soc. 2005:53:1944-1950.

Using data from the Massachusetts Framingham Heart Study of 2,531 men and women, information gathered during at least 2 examinations between age 40-50 years was compared to overall survival and morbidity up to age 85. Risk factors analyzed included nationally accepted guidelines for values of systolic and diastolic blood pressure, serum cholesterol level, body mass index, presence of diabetes, and smoking status; additional factors analyzed were educational level, physical activity index, pulse pressure, antihypertensive medication, and electrocardiographic evidence of left ventricular hypertrophy.

Predicted probability of survival to age 85 was greatest in women with no risk factors (65% vs 14% with 5 factors), and less in men (37% with no factors vs 2% with 5 factors). Increased risk of early death and morbidity increased with the number of risk factors, of which the most influential were lower midlife blood pressure and total cholesterol levels, absence of glucose intolerance, nonsmoking status, and higher educational attainment. Fully one-third of the Framingham participants survived to age 85, and 22% of those were free of morbidity.

Commentary

These data provide further evidence to use in motivating our patients to modify their cardiovascular risk factors in middle age. There has been concern that the longer survival we hope for may be marked by increased disease at older ages, but this study, along with others1 with long-term follow-up, support the premise that favorable cardiovascular risk profiles in middle age lead to both better quality of life and lower risk of diseases in older age. It is disappointing that the survival for men was markedly less than for women with similar risk factors, which suggests other unidentified influences are contributing to this difference.

The relative importance of the different risk factors varies in the current medical literature. A recent Finnish study which followed 47,212 men and women for a mean of 18 years pointed to a lack of physical activity as the most influential predictive factor for early mortality and morbidity; this was associated with obesity which was accompanied by more cardiovascular risk factors.2 In this group, women with obesity had more early mortality than men (18% vs 6%).

Other than living in the Framingham area of Massachusetts, where a remarkably large portion of the population live to age 85, it seems most likely that increased years of survival with minimal morbidity can be gained from a combination of factors, many of which may be modifiable in middle age.

References

1. Daviglus ML, et al. Favorable cardiovascular risk profile in middle age and health-related quality of life in older age. Arch Intern Med. 2003;163:2460-2468.

2. Hu G, et al. The effects of physical activity and body mass index on cardiovascular, cancer and all-cause mortality among 47,212 middle-aged Finnish men and women. Int J Obes (Lond). 2005;29:894-902.