Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study

OBJECTIVE: To examine how a healthy lifestyle is related to life expectancy that is free from major chronic diseases. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: The Nurses' Health Study (1980-2014; n=73 196) and the Health Professionals Follow-Up Study (1986-2014; n=38 366). MAIN EXPOSURES: Five low risk lifestyle factors: never smoking, body mass index 18.5-24.9, moderate to vigorous physical activity (≥30 minutes/day), moderate alcohol intake (women: 5-15 g/day; men 5-30 g/day), and a higher diet quality score (upper 40%). MAIN OUTCOME: Life expectancy free of diabetes, cardiovascular diseases, and cancer. RESULTS: The life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 was 23.7 years (95% confidence interval 22.6 to 24.7) for women who adopted no low risk lifestyle factors, in contrast to 34.4 years (33.1 to 35.5) for women who adopted four or five low risk factors. At age 50, the life expectancy free of any of these chronic diseases was 23.5 (22.3 to 24.7) years among men who adopted no low risk lifestyle factors and 31.1 (29.5 to 32.5) years in men who adopted four or five low risk lifestyle factors. For current male smokers who smoked heavily (≥15 cigarettes/day) or obese men and women (body mass index ≥30), their disease-free life expectancies accounted for the lowest proportion (≤75%) of total life expectancy at age 50. CONCLUSION: Adherence to a healthy lifestyle at mid-life is associated with a longer life expectancy free of major chronic diseases

A real-world study of the association between cardiovascular risk factors and depression symptom trajectory in individuals with mental illness

Background: We examined the relationship between baseline cardiovascular (CV) disease/risk factors and longitudinally-collected scores on the patient health questionnaire (PHQ-9) depression scale using an outpatient sample of individuals with mental illness (PCARES Registry, 2015–2020). Methods: Individuals with ≥2 repeated PHQ-9 assessments over one-year from the baseline PHQ-9 measurement (N = 2110) were included for trajectory modeling, with five depression symptom severity trajectory groups determined a priori (lowest, lower, middle, higher, and highest). Proportional odds models provided the association between baseline CV disease/risk factors and the odds of belonging to the more severe depression symptom trajectory group. In a sub-sample (baseline PHQ-9 score ≥10), linear-mixed effects models provided the association between baseline CV disease/risk factors and longitudinal PHQ-9 scores (N = 1118). Results: 2110 individuals included 65% females, 87% non-Hispanic white, 50% in lower and middle severity groups, with mean ± SD age: 43.0 ± 16.8 years and PHQ-9 score: 10.8 ± 7.0. Adjusting for socio-demographics and BMI [OR (95% CI)]: individuals with baseline hypertension [1.4 (1.2–1.7)], diabetes [1.3 (1.0–1.6)], dyslipidemia [1.2 (1.0–1.4)], tobacco use [2.0 (1.6–2.6)], and higher number of CV disease/risk factors (P-trend<0.0001) had significantly higher odds of more severe depression symptom trajectories; longitudinal PHQ-9 scores significantly decreased during 1-year follow-up, and the decrease was relatively lesser in individuals with hypertension or ≥1 CV disease/risk factors than those without these conditions. Limitations: Clinic-based patient sample limits generalizability of findings. Conclusions: Presence/absence of baseline CV risk factors significantly influenced longitudinal depression symptom severity among psychiatry outpatients, demonstrating the need for depression screening and surveillance among individuals with CV risk factors