In this cross-sectional study of 5364 couples consisting of employees and spouses (or domestic partners) undergoing an annual employer-sponsored health assessment, 79% of the couples were in the nonideal category of a CV health score. This within-couple concordance of nonideal CV health scores was associated mostly with unhealthy diet and inadequate physical activity.
The study included 10 728 participants (5364 couples): 7% were African American, 11% Hispanic, 21% Asian, and 54% White (median [interquartile range] age, 50 [41-57] years for men and 47 [39-55] for women). For most couples, both members were in the ideal category or both were in a nonideal category.
Concordance ranged from 53% (95% CI, 52%-54%) for cholesterol to 95% (95% CI, 94%-95%) for diet. For the CV health score, in 79% (95% CI, 78%-80%) of couples both members were in a nonideal category, which was associated mainly with unhealthy diet (94% [95% CI, 93%-94%] of couples) and inadequate exercise (53% [95% CI, 52%-55%] of couples). However, in most couples, both members were in the ideal category for smoking status (60% [95% CI, 59%-61%] of couples) and glucose (56% [95% CI, 55%-58%]).
Except for total cholesterol, when 1 member of a couple was in the ideal category, the other member was likely also to be in the ideal category: the adjusted odds ratios for also being in the ideal category ranged from 1.3 (95% CI, 1.1-1.5; P ≤ .001) for blood pressure to 10.6 (95% CI, 7.4-15.3; P ≤ .001) for diet. Concordance differed by ethnicity, socioeconomic status, and geographic location.
The number of older people, including those living with dementia, is rising, as younger age mortality declines. However, the age-specific incidence of dementia has fallen in many countries, probably because of improvements in education, nutrition, health care, and lifestyle changes.
Overall, a growing body of evidence supports the nine potentially modifiable risk factors for dementia modelled by the 2017 Lancet Commission on dementia prevention, intervention, and care: less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and low social contact.
We now add three more risk factors for dementia with newer, convincing evidence. These factors are excessive alcohol consumption, traumatic brain injury, and air pollution. We have completed new reviews and meta-analyses and incorporated these into an updated 12 risk factor life-course model of dementia prevention. Together the 12 modifiable risk factors account for around 40% of worldwide dementias, which consequently could theoretically be prevented or delayed.
The potential for prevention is high and might be higher in low-income and middle-income countries (LMIC) where more dementias occur. Our new life-course model and evidence synthesis has paramount worldwide policy implications. It is never too early and never too late in the life course for dementia prevention. Early-life (younger than 45 years) risks, such as less education, affect cognitive reserve; midlife (45–65 years), and later-life (older than 65 years) risk factors influence reserve and triggering of neuropathological developments.
Culture, poverty, and inequality are key drivers of the need for change. Individuals who are most deprived need these changes the most and will derive the highest benefit.
“We are learning that tactics to avoid dementia begin early and continue throughout life, so it’s never too early or too late to take action,” says commission member and AAIC presenter Lon Schneider, MD, co-director of the USC Alzheimer Disease Research Center‘s clinical core and professor of psychiatry and the behavioral sciences and neurology at the Keck School of Medicine of USC.
LOS ANGELES — Modifying 12 risk factors over a lifetime could delay or prevent 40% of dementia cases, according to an updated report by the Lancet Commission on dementia prevention, intervention and care presented at the Alzheimer’s Association International Conference (AAIC 2020).
Twenty-eight world-leading dementia experts added three new risk factors in the new report — excessive alcohol intake and head injury in mid-life and air pollution in later life. These are in addition to nine factors previously identified by the commission in 2017: less education early in life; mid-life hearing loss, hypertension and obesity; and smoking, depression, social isolation, physical inactivity and diabetes later in life (65 and up).
Schneider and commission members recommend that policymakers and individuals adopt the following interventions:
- Aim to maintain systolic blood pressure of 130 mm Hg or less from the age of 40.
- Encourage use of hearing aids for hearing loss and reduce hearing loss by protecting ears from high noise levels.
- Reduce exposure to air pollution and second-hand tobacco smoke.
- Prevent head injury (particularly by targeting high-risk occupations).
- Limit alcohol intake to no more than 21 units per week (one unit of alcohol equals 10 ml or 8 g pure alcohol).
- Stop smoking and support others to stop smoking.
- Provide all children with primary and secondary education.
- Lead an active life into mid-life and possibly later life.
- Reduce obesity and the linked condition of diabetes.
From a BMJ online article:
We derived a healthy lifestyle score based on information on five lifestyle factors—diet, smoking, physical activity, alcohol consumption, and body mass index (BMI).
Our findings suggest that promotion of a healthy lifestyle would help to reduce the healthcare burdens through lowering the risk of developing multiple chronic diseases, including cancer, cardiovascular disease, and diabetes, and extending disease-free life expectancy. Public policies for improving food and the physical environment conducive to adopting a healthy diet and lifestyle, as well as relevant policies and regulations (for example, smoking ban in public places or trans-fat restrictions), are critical to improving life expectancy, especially life expectancy free of major chronic diseases.
The average life expectancy in the world has increased substantially in the past few decades. The aging of the population has led to a high prevalence of chronic diseases such as diabetes, cardiovascular disease, and cancer. Although people live longer, older individuals often live with disabilities and chronic diseases. People with chronic diseases including cancer, cardiovascular disease, and diabetes have a shorter life expectancy than do their peers without these chronic conditions. Estimates of the loss in life years due to these chronic conditions range from 7.5 to 20 years, depending on the methods used and the characteristics of the study population.
Modifiable lifestyle factors including smoking, physical activity, alcohol intake, body weight, and diet quality affect both total life expectancy and incidence of chronic diseases. Studies have shown that smoking, inactivity, poor diet quality, and heavy alcohol consumption contribute up to 60% of premature deaths and 7.4-17.9 years’ loss in life expectancy. Nevertheless, little research has looked at how a combination of multiple lifestyle factors may relate to life expectancy free from the major diseases of diabetes, cardiovascular disease, and cancer.
From a ScienceDaily.com online release:
Physical inactivity, smoking, high blood pressure, diabetes, and high cholesterol play a greater role than genetics in many young patients with heart disease, according to research presented today at ESC Congress 2019 together with the World Congress of Cardiology. The findings show that healthy behaviours should be a top priority for reducing heart disease even in those with a family history of early onset.
The study enrolled 1,075 patients under 50, of whom 555 had coronary artery disease (known as premature CAD). Specific conditions included stable angina, heart attack, and unstable angina. The average age was 45 and 87% were men. Risk factor levels and genetics in patients were compared to a control group of 520 healthy volunteers (average age 44, and 86% men). Patients and controls were recruited from the Genes in Madeira and Coronary Disease (GENEMACOR) database.
Five modifiable risk factors were assessed: physical inactivity, smoking, high blood pressure, diabetes, and high cholesterol. Nearly three-quarters (73%) of patients had at least three of these risk factors compared to 31% of controls. In both groups, the likelihood of developing CAD increased exponentially with each additional risk factor. The probability of CAD was 3, 7, and 24 times higher with 1, 2, and 3 or more risk factors, respectively.