Healthy lifestyle and longevity

Researchers from the Harvard T.H. Chan School of Public Health conducted a massive study of the impact of health habits on life expectancy, using data from the well-known Nurses Health Study (NHS) and the Health Professionals Follow-up Study (HPFS). This means that they had data on a huge number of people over a very long period of time. The NHS included over 78,000 women and followed them from 1980 to 2014. The HPFS included over 40,000 men and followed them from 1986 to 2014. This is over 120,000 participants, 34 years of data for women, and 28 years of data for men.

The researchers looked at NHS and HPFS data on diet, physical activity, body weight, smoking, and alcohol consumption that had been collected from regularly administered, validated questionnaires.

What is a healthy lifestyle, exactly?

These five areas were chosen because prior studies have shown them to have a large impact on risk of premature death. Here is how these healthy habits were defined and measured:

1.   Healthy diet, which was calculated and rated based on the reported intake of healthy foods like vegetables, fruits, nuts, whole grains, healthy fats, and omega-3 fatty acids, and unhealthy foods like red and processed meats, sugar-sweetened beverages, trans fat, and sodium.

2.  Healthy physical activity level, which was measured as at least 30 minutes per day of moderate to vigorous activity daily.

3.   Healthy body weight, defined as a normal body mass index (BMI), which is between 18.5 and 24.9.

4.   Smoking, well, there is no healthy amount of smoking. “Healthy” here meant never having smoked.

5.   Moderate alcohol intake, which was measured as between 5 and 15 grams per day for women, and 5 to 30 grams per day for men. Generally, one drink contains about 14 grams of pure alcohol. That’s 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of distilled spirits.

Researchers also looked at data on age, ethnicity, and medication use, as well as comparison data from the National Health and Nutrition Examination Surveys and the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research.

The guidelines from the American Heart Association and the American College of Cardiology were presented at an ACC annual meeting

Led by a group of the country’s leading doctors and scientists. They put under one umbrella an array of research-based recommendations for doctors to use in counseling patients.

Heart disease and stroke are the leading causes of death, responsible for an estimated 17 million deaths every year worldwide. In the United States, cardiovascular disease is listed as the underlying cause in 840,678 deaths – about 1 out of every 3, according to the latest AHA statistics.

“The intent is to pull together all areas for primary prevention into one single file, a kind of one-stop shop for prevention,” said Donna Arnett, co-chair of the 18-person writing committee. “One of the unique additions in this guideline is that we approached it from the patient’s perspective.

“For example, if clinicians are thinking about how to advise a patient on how to eat a healthy diet, they should consider that there may be cultural factors or economic factors at play. We encourage fresh fruits and vegetables, but for some patients with food security issues, they may not always be affordable or accessible,” said Arnett, dean of the University of Kentucky College of Public Health and a professor in the department of epidemiology. “We want to understand and meet patients where they are; it’s a fundamental focus of this guideline.”

“We see it all the time as health care providers. There are a lot of barriers,” said Yeboah, an associate professor of cardiology at Wake Forest School of Medicine in North Carolina.

“We all come from different backgrounds and perceive disease differently,” said Yeboah, who was born and grew up in the west African country of Ghana. “In some cultures, disease is something that hurts, and if it doesn’t then it’s not disease.

“When you have high blood pressure, for example, it doesn’t hurt. So, you have to let (patients) know there are consequences to high blood pressure,” he said. “It’s up to health care providers to address that barrier first so that the person will accept the treatment plan. The treatment plan should start with minimising salt intake, exercising, weight loss and, if needed, medications.”

For adults older than 40, the guidelines reiterate recommendations that doctors use a risk calculator to help estimate a patient’s chance of developing cardiovascular disease within the next 10 years – and that doctors then have a “client-patient risk discussion” before starting a patient on medicines.

 American Heart Association

American Heart Association

Exercising

Exercise, the guidelines include recommendations, based on recent federal government guidelines, that adults should engage in at least 150 minutes a week of moderate-intensity physical activity or 75 minutes a week at a vigorous pace.

Yeboah said the emphasis on having doctors counsel their patients about healthy living shows an important shift. “We go right to behavioural and lifestyle changes first to minimize cardiovascular disease risk, before adding medication.”

Although the guidelines corral together many individual areas related to preventing cardiovascular disease, Arnett said the overarching theme is rather simple.

“Healthy living, with diet and exercise,” she said, “is the primary line of defense in preventing heart disease.