Effect of major lifestyle risk factors, independent and jointly, on life expectancy with and without cardiovascular disease: results from the Consortium on Health and Ageing Network of Cohorts in Europe and the United States (CHANCES)
Eur J Epidemiol
Effect of major lifestyle risk factors, independent and jointly, on life expectancy with and without cardiovascular disease: results from the Consortium on Health and Ageing Network of Cohorts in Europe and the United States (CHANCES)
Mark G. O'Doherty 0 1 2 3 4 5 6 7 8 9
Karen Cairns 0 1 2 3 4 5 6 7 8 9
Vikki O'Neill 0 1 2 3 4 5 6 7 8 9
Felicity Lamrock 0 1 2 3 4 5 6 7 8 9
Torben Jørgensen 0 1 2 3 4 5 6 7 8 9
Hermann Brenner 0 1 2 3 4 5 6 7 8 9
Ben Sch o¨ttker 0 1 2 3 4 5 6 7 8 9
Tom Wilsgaard 0 1 2 3 4 5 6 7 8 9
Galatios Siganos 0 1 2 3 4 5 6 7 8 9
Kari Kuulasmaa 0 1 2 3 4 5 6 7 8 9
Paolo Boffetta 0 1 2 3 4 5 6 7 8 9
Antonia Trichopoulou 0 1 2 3 4 5 6 7 8 9
Frank Kee 0 1 2 3 4 5 6 7 8 9
0 Centre for Statistical Science and Operational Research (CenSSOR), Queen's University Belfast , Belfast BT7 1NN, Northern Ireland , UK
1 UKCRC Centre of Excellence for Public Health for Northern Ireland, Queens University Belfast , Belfast BT12 6BA, Northern Ireland , UK
2 Mark G. O'Doherty
3 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens , Mikras Asias 75 st, 115 27 Athens , Greece
4 Hellenic Health Foundation , Kaisareias 13 & Alexandroupoleos str., 115 27 Athens , Greece
5 The Tisch Cancer Institute and Institute for Translational Epidemiology, Mount Sinai School of Medicine , New York, NY 10029 , USA
6 Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ) , Im Neuenheimer Feld 581, 69120 Heidelberg , Germany
7 Faculty of Medicine, University of Aalborg , Aalborg , Denmark
8 Institute of Public Health, University of Copenhagen , Copenhagen , Denmark
9 Research Centre for Prevention and Health, Glostrup University Hospital , Glostrup , Denmark
Seldom have studies taken account of changes in lifestyle habits in the elderly, or investigated their impact on disease-free life expectancy (LE) and LE with cardiovascular disease (CVD). Using data on subjects aged 50? years from three European cohorts (RCPH, ESTHER and Tromsø), we used multi-state Markov models to calculate the independent and joint effects of smoking, physical activity, obesity and alcohol consumption on LE with and without CVD. Men and women aged 50 years who have a favourable lifestyle (overweight but not obese, light/moderate drinker, non-smoker and participates in vigorous physical activity) lived between 7.4 (in Tromsø men) and 15.7 (in ESTHER women) years longer than those with an unfavourable lifestyle (overweight but not obese, light/moderate drinker, smoker and does not participate in physical activity). The greater part of the extra life years was in terms of ''disease-free'' years, though a healthy lifestyle was also associated with extra years lived after a CVD event. There are sizeable benefits to LE without CVD and also for survival after CVD onset when people favour a lifestyle characterized by salutary behaviours. Remaining a non-smoker yielded the greatest extra years in overall LE, when compared to the effects of routinely taking physical activity, being overweight but not obese, and drinking in moderation. The majority of the overall LE benefit is in disease free years. Therefore, it is important for policy makers and the public to know that prevention through maintaining a favourable lifestyle is ''never too late''.
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On behalf of the CHANCES consortium.
Department of Community Medicine, University of Tromsø,
9037 Tromsø, Norway
Department of Health, National Institute for Health and
Welfare (THL), 00271 Helsinki, Finland
Ageing Smoking
Mortality
Obesity
Introduction
The World Health Organization estimates that 17.3 million
people died from cardiovascular diseases (CVD) in 2008,
representing 30 % of all deaths [
1
]. Of these deaths, 7.3
million resulted from coronary heart disease (CHD) and 6.2
million from stroke [
1
]. By 2030, almost 23.6 million
people will die from CVD, mainly from CHD and stroke,
and these are projected to remain the single leading causes
of death [
2
].
Across the European region there are significant
variations in total life expectancy (LEtot) and in the proportion
of life expectancy (LE) lived without significant
self-reported disease or disability [
3
]. As our LEtot increases,
whether or not the number of years lived with morbidity in
old age will be compressed [
4
] is a subject of some debate.
Some risk factors in older age may affect incidence and
mortality in divergent ways. Obesity for example increases
incidence risk but apparently has either no effect or may be
protective among those who have experienced a
cardiovascular event [
5
]. While there has been some decline in
the prevalence of smoking, current trends in physical
activity, obesity and alcohol consumption are adverse. Few
studies, however, have investigated the independent and
joint effects of these lifestyle factors on LEtot and LE free
of CVD [
6
]. Previous studies suggest that not smoking [
7
],
moderate/high level (...truncated)