Abstract MP70: Impact of Cardiovascular Health Metrics on Life Expectancy and All-cause Mortality in Middle-aged and Elderly Men and Women

Abstract

Purpose: We investigated the combined impact of 7 ideal cardiovascular health metrics on life expectancy and lifetime risk of all-cause mortality in middle-aged and elderly US men and women. Methods: Cox proportional hazards regression was used to examine the associations of single and combined number of 7 health metrics and all-cause mortality after adjustment for multiple risk factors. Survival analysis (modified version) was used to compute lifetime risk of all-cause mortality at 40 years of age to 80, with death free of chronic diseases as a competing event. We followed 7,848 men and women, aged 40 to 80 years, who participated in the Third National Health and Nutrition Examination Survey. All participants completed baseline lifestyle factors and lifestyle behavior questionnaires. The 7 ideal cardiovascular health metrics were defined as physically active, never smoked, a healthy diet, waist girth (<102/88 cm), untreated blood pressure (<120/80 mmHg), untreated total cholesterol (<200 mg/dL), and untreated fasting glucose (<100 mg/dL) defined by the American Heart Association (AHA). We further categorized these variables as having 0, 1, 2, 3, 4, 5, 6 or 7 combined cardiovascular health metrics. Results: During an average of 13.2 years of follow-up (103,851 person-years), there were a total of 2,297 all-cause deaths (915 CVD, 546 cancer, 210 respiratory disease, 86 diabetes mellitus). After adjustment for multiple risk factors, men and women with all 6 or 7 combined ideal health metrics had a 68% (95% CI: 43% to 83%) lower risk of all-cause mortality compared with men and women with zero ideal health metrics. The lifetime risks of all-cause mortality (at 40 years of age) across 0, 1, 2, 3, 4, 5, and 6 or 7 ideal health metrics were (95% CI) 60.2% (55.6, 64.8), 51.9% (48.4, 55.4), 43.6% (40.3, 46.9), 37.1% (33.0, 41.3), 35.1% (29.6, 40.5), 33.8% (24.8, 42.8), and 19.4% (5.1, 33.7), respectively. Men and women with increasing number ideal health metrics had a substantially lower lifetime risk of all-cause mortality. Men and women with 6 or 7 compared with 0 combined ideal health metrics had a longer life expectancy by 13.5 years (95% CI: 6.8 to 19.5 years). Approximately 53% (95% CI: 15% to 74%) of all-cause deaths might have been avoided if men and women had adopted all 6 or 7 combined health factors and healthy lifestyle behaviors. Conclusion: Adopting the AHA’s 7 ideal cardiovascular health metrics is associated with lower lifetime risk of all-cause mortality and longer life expectancy in middle-aged and elderly US men and women.