Location of Repository

Living healthier for longer: comparative effects of three heart-healthy behaviors on life expectancy with and without cardiovascular disease

By Wilma J. Nusselder, Oscar H. Franco, Anna Peeters and J. P. Mackenbach


Background: Non-smoking, having a normal weight and increased levels of physical activity are perhaps the three key factors for preventing cardiovascular disease (CVD). However, the relative effects of these factors on healthy longevity have not been well described. We aimed to calculate and compare the effects of non-smoking, normal weight and physical activity in middle-aged populations on life expectancy with and without cardiovascular disease. \ud Methods: Using multi-state life tables and data from the Framingham Heart Study (n = 4634) we calculated the effects of three heart healthy behaviours among populations aged 50 years and over on life expectancy with and without cardiovascular disease. For the life table calculations, we used hazard ratios for 3 transitions (No CVD to CVD, no CVD to death, and CVD to death) by health behaviour category, and adjusted for age, sex, and potential confounders. \ud Results: High levels of physical activity, never smoking (men), and normal weight were each associated with 20-40% lower risks of developing CVD as compared to low physical activity, current smoking and obesity, respectively. Never smoking and high levels of physical activity reduced the risks of dying in those with and without a history of CVD, but normal weight did not. Never-smoking was associated with the largest gains in total life expectancy (4.3 years, men, 4.1 years, women) and CVD-free life expectancy (3.8 and 3.4 years, respectively). High levels of physical activity and normal weight were associated with lesser gains in total life expectancy (3.5 years, men and 3.4 years, women, and 1.3 years, men and 1.0 year women, respectively), and slightly lesser gains in CVD-free life expectancy (3.0 years, men and 3.1 years, women, and 3.1 years men and 2.9 years women, respectively). Normal weight was the only behaviour associated with a reduction in the number of years lived with CVD (1.8 years, men and 1.9 years, women). \ud Conclusions: Achieving high levels of physical activity, normal weight, and never smoking, are effective ways to prevent cardiovascular disease and to extend total life expectancy and the number of years lived free of CVD. Increasing the prevalence of normal weight could further reduce the time spent with CVD in the population

Topics: RA0421
Publisher: BioMed Central Ltd.
Year: 2009
OAI identifier: oai:wrap.warwick.ac.uk:2689

Suggested articles



  1. Association: Statistical Factsheet Population: International Cardiovascular disease Statistics.
  2. (2009). Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet
  3. (2003). Bonneux L: Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med doi
  4. (2003). Capewell S: Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. Jama doi
  5. (1998). Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. Obes Res doi
  6. (1987). D'Agostino RB: The relative importance of selected risk factors for various manifestations of cardiovascular disease among men and women from 35 to 64 years old: 30 years of follow-up in the Framingham Study. Circulation
  7. (1996). Department of Health and Human Services: Physical Actvity and Health: A Report of the Surgeon General. doi
  8. (1990). Department of Health and Human Services: The Health Benefits of Smoking cessation: A Report of the Surgeon General. doi
  9. (2005). Diverse Populations C: Body mass index and mortality: a meta-analysis based on person-level data from twentysix observational studies. Ann Epidemiol doi
  10. (1951). Epidemiological approaches to heart disease: the Framingham Study. doi
  11. (2007). et al.: Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than 300 000 persons. Archives of internal medicine
  12. (2004). et al.: Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet doi
  13. (2004). Fonarow GC: Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. doi
  14. (2009). Human Mortality Database [http://www.mortality.org]. (data downloaded on 23th
  15. (2004). I: Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ (Clinical research ed) doi
  16. (1998). JL: The effect of age on the association between body-mass index and mortality. doi
  17. (1988). Kannel WB: Comparison of baseline and repeated measure covariate techniques in the Framingham Heart Study. Stat Med doi
  18. (2006). Lopez-Jimenez F: Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet doi
  19. (1988). Modelling multigroup populations doi
  20. (2005). Nusselder W: Effects of physical activity on life expectancy with cardiovascular disease. Archives of internal medicine doi
  21. (2006). Nusselder WJ: Physical activity and life expectancy with and without diabetes: life table analysis of the Framingham Heart Study. Diabetes Care doi
  22. (2010). of Health and Human Services: Healthy People Understanding and Improving Health Volume I-II. 2nd edition. Washington DC: US Department of Health and Human Services; doi
  23. (2006). Peeters A: Adult obesity and number of years lived with and without cardiovascular disease. Obesity (Silver Spring) doi
  24. (2006). Peeters A: Successful aging: measuring the years lived with functional loss. doi
  25. (2000). Physical activity and mortality in older men with diagnosed coronary heart disease. Circulation doi
  26. (2004). Smoking decreases the duration of life lived with and without cardiovascular disease: a life course analysis of the Framingham Heart Study. Eur Heart J doi
  27. (1979). Some health benefits of physical activity. The Framingham Study. Archives of internal medicine doi
  28. (2006). Statistics NCfH: Chartbook on Trends in the Health of Americans.
  29. (2005). The Bradford Hill considerations on causality: a counterfactual perspective. Emerging themes in epidemiology
  30. (1993). Tibshirani RJ: An introduction to the Bootstrap. doi

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.