Unlike death and taxes, cardiovascular disease may be avoided

If you take good care of yourself, you just might end up avoiding cardiovascular disease (CVD), the most common killer in this country. That’s the bottom line from a study published this week in JAMA.

Researchers from Northwestern University’s Feinberg School of Medicine have been investigating how the presence of four major modifiable risk factors for cardiovascular disease—high cholesterol, high blood pressure, diabetes, and smoking—in middle age affect the risk of heart disease over the rest of the lifetime. Their earlier work showed that more than 50% of those in middle age with two or more factors were likely to ever have a heart attack or stroke, compared to under 10% of 50-year-olds with no risk factors. Their latest work boosts those estimates, but still offers some reassurance.

The researchers analyzed five long-term studies which documented cardiovascular risk factors for 120,000 individuals at ages 45, 55, 65, and 75. This time they cast a broader net and tallied up all cardiovascular events—nonfatal and fatal heart attack and stroke, angina, the need for angioplasty or bypass surgery, heart failure, and death due to cardiovascular disease.

As you might expect, the percentages of people who experienced one of these “events” was huge, above 50% at all four ages (see table).

However, those with an optimal risk factor profile—non-smoker, no diabetes, blood pressure less than 120/80 mm Hg, and total cholesterol less than 180 mg/dL—had a much lower lifetime risk of cardiovascular disease. For example, men and women with optimal profiles at age 55 were 30% to almost 50% less likely to develop cardiovascular disease than those with two or more major risk factors. They also lived an average of 14 years longer free of cardiovascular disease.

But few of us get gold stars. At age 55, only 4% of the people in the studies had an optimal cardiovascular risk profile, and more than 50% had one or more major risk factors.

“I don’t think cardiovascular disease is inevitable by any means,” says Harvard internist Dr. Howard LeWine. “If we had better diets starting in early childhood, and remained physically active throughout life, far fewer of us would develop this degenerative disease.”

That’s a pretty big incentive to watch your blood pressure, blood sugar, and cholesterol levels, and to kick the smoking habit, if you haven’t already.

“It’s not just about how long you live; you also want quality of life—the ability to do things you enjoy as you age,” he says.

A lot of doctors, including Dr. LeWine, were surprised that even if you do everything right to lower your risk, cardiovascular disease can still happen. This means there is a lot more we need to learn about how to keep the heart healthy. It also underscores the importance of paying attention to your risk factors throughout your life.

“If you have made it to an older age without developing cardiovascular disease, your risk is still pretty high, so don’t take your good luck for granted,” says Dr. LeWine. “You are never too old to exercise or quit smoking. It may give you more years when you—not your disease—are in control of your life.”