Avoidance of Mid-Life Risk Factors Linked to Long, Healthy Lives in Men

Press Release

Honolulu -- Avoiding 9 major risk factors in midlife, particularly those linked to insulin levels such as overweight, high blood sugar, high triglycerides (a type of cholesterol) and high blood pressure is a strong predictor of whether you will survive to old age and if you do, whether you will be healthy, according to a study in the November 15 issue of the Journal of the American Medical Association.

Bradley J. Willcox, M.D., a National Institutes of Health-funded scientist in Geriatrics at the Pacific Health Research Institute in Honolulu, HI. and Dr. David Curb, CEO of the Pacific Health Research Institute, was Principal Investigator and C0-Principal Investigator of the study, known as the Hawaii Lifespan Study. Dr. Willcox is also an Internal Medicine and Geriatrics physician-scientist at Queen's and Kuakini Medical Centers, Clinical Assistant Professor in the Department of Geriatric Medicine, John. A. Burns School of Medicine, University of Hawaii, and co-Principal Investigator of the Okinawa Centenarian Study.

The study investigated factors of major interest to baby boomers-that is what factors predict survival from midlife (age 55 years) until age 90 years, and how to maximize one's healthy years. Baby boomers are on their way to becoming senior citizens and in fact, the "oldest-old (ages 85-plus) are the fastest-growing age group in most industrialized countries and are among the largest consumers of health care resources. Identifying strategies for remaining healthy, vigorous, and disability-free at older ages has become a major priority.

Dr. Willcox and colleagues studied potential biological, lifestyle, and sociodemographic risk factors present at middle age in order to find risk factors that could indicate odds for healthy survival. The study, known as the Hawaii Lifespan Study, included 5,820 Japanese-American men (average age 54 years) in the Kuakini Honolulu Heart Program/Honolulu Asia Aging Study. AT the baseline exam, in 1965, the participants were free of illness and functional impairments. They were then followed for up to 40 years (1965-2005) to assess overall and healthy or "exceptional" survival.

Exceptional survival was defined as survival to a specified age (75, 80, 85, or 90 years) without incidence of 6 major chronic diseases and without physical and cognitive impairment. The diseases studied were diseases that are particularly associated with advancing age. These included coronary heart disease, stroke, cancer (excluding nonmelanoma skin cancer), chronic obstructive pulmonary disease, Parkinson disease, and treated diabetes. From 5,820 original participants, 2,451 participants (42 percent) survived to age 85 years and 655 participants (11 percent) met the criteria for healthy survival to age 85 years.

High grip strength (an indictor of both overall strength and fitness) and avoidance of overweight, hyperglycemia, hypertension, smoking, and excessive alcohol consumption were associated with both overall and healthy survival. In addition, high education and avoidance of elevated triglycerides (a type of bad cholesterol) were associated with healthy survival. Lack of a marital partner was associated with death before age 85 years.

Interestingly, a risk factor model was created that survival risk score that showed that the probability of survival to age 80 years was approximately 80% with 0/9 risk factors and dipper to only about 20% with 6 or more risk factors. The probability of exceptional (healthy) survival to age 85 years was 55 percent with no risk factors but decreased to 9 percent with 6 or more risk factors

"In the authors words' "in summary, we have identified several potentially important risk factors for healthy survival in a large group of middle-aged men. These risk factors can be easily measured in clinical settings and are, for the most part, modifiable. This study suggests that common approaches that target multiple risk factors simultaneously, such as avoidance of smoking or hypertension, and approaches that enhance insulin sensitivity, such as maintaining a lean body weight, may improve the probability of better health at older ages. This may be especially important for men, few of whom survive to oldest-old age. "

(For the full study see the Willcox B et al. Journal of the American Medical Association 2006;296:2343-2350)

This study was supported by a contract from the National Heart, Lung, and Blood Institute, a contract and grants (including Hawaii Lifespan Study) from the National Institute on Aging, and a grant from the Hawaii Community Foundation).