Even the healthiest middle-age Americans have a 1 in 3 chance of heart problems or a stroke later in life, a new study finds. But they'll avoid these diseases longer than less healthy peers. These estimates are based on numbers from 5 large, long-term studies. They included nearly 50,000 people ages 45 and older. Authors of the new study looked at long-term health for people based on whether they had health conditions that increase risk. The healthiest adults were those who didn't smoke and didn't have diabetes, high blood pressure or high cholesterol. Among those who fit this healthy profile at age 55, about one-third developed heart or blood vessel problems. The problems included a heart attack, stroke, heart failure, chest pain caused by clogged arteries, or death related to one of these conditions. But the healthiest 55-year-olds stayed free of these problems about 7 years longer than those who were least healthy at 55. The least healthy group had 2 or more risk factors, such as smoking or diabetes. The Journal of the American Medical Association published the study online. The Associated Press wrote about it November 5.

By Howard LeWine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Even if you have don't have heart or blood vessel disease in middle age, your risk of developing it is still high. This is the conclusion of new research results. The Journal of the American Medical Association published the study.

John Wilkins, M.D., and his colleagues looked at the lifetime risks of having any of the following:

• A heart attack
• Angina (chest pain) caused by clogged heart arteries
• Stroke
• Heart failure
• Death related to coronary artery disease or stroke

The researchers created computer models based on a huge amount of information gathered from five different long-running studies. They calculated lifetime heart and stroke risks for men and women at ages 45, 55, 65 and 75. People chosen for the study had no evidence of heart or blood vessel disease when the study began. But many developed it over time.

Based on this study, the average lifetime risk of developing one of these conditions for a 45-year-old man is 60%. For a 45-year-old woman, the average lifetime risk is almost 56%.

The researchers also looked at the lifetime chance based on the traditional risk factors for coronary artery disease:

• Smoking
• Diabetes
• Blood pressure
• Cholesterol level

The researchers wanted to find out how these risk factors impact the chance of developing one of the conditions related to the heart and blood vessels. So they defined an ideal risk profile:

• Not smoking
• No diabetes
• Blood pressure less than 120/80 millimeters of mercury
• Total cholesterol less than 180 milligrams per deciliter

The researchers calculated that a 55-year old man with an ideal profile still has a 40% risk of developing heart and/or blood vessel disease by age 85. A 55-year-old woman with a similar profile has a 30% risk.

What Changes Can I Make Now?

No matter what your age and how good things look today, your future risk of heart disease, stroke and other related diseases is high. It's true for all of us.

That's why it's so important to do all you can to lower your risk:

• Never smoke, or at least quit smoking right away. It's never too late to quit. Your risk of a heart attack starts to decrease within weeks of quitting.
• Avoid type 2 diabetes by maintaining a healthy weight, avoiding simple sugars and staying physically active. If you already have pre-diabetes, you need to take action right away.
• Take steps to help keep your blood pressure in the normal range. Eat a diet rich in fruits and vegetables and limit salt intake. If lifestyle changes are not enough to get your blood pressure down, you have lots of medicine options that work.
• Reduce saturated fats in your diet to help lower your LDL cholesterol level. Some people may also need a statin drug to lower LDL. This depends on how high your LDL is and your other heart disease risk factors.

What Can I Expect Looking to the Future?

There is concern that we may have reached a peak in average lifespan, and that it may start to decline. But this does not need to happen. If we all took this lifetime risk of heart and blood vessel disease seriously, starting in childhood, we could continue to make gains in how long people live. And, more importantly, we can improve our quality of life along the way.