Risk and the middle-aged heart

If you avoid smoking and have your blood pressure and cholesterol under good control when you’re in your 40s, it’s likely to pay off with less chance of heart disease by the time you’re 80. Ignore your cardiovascular risk factors in middle age and it could come back to haunt you later.

This seems to be one of the take-home messages in a study newly published in the New England Journal of Medicine that examines the lifetime risk of cardiovascular disease.

The researchers analyzed data from the Cardiovascular Lifetime Risk Pooling Project, a collection of 18 studies involving more than 250,000 American adults that measured their cardiovascular risk factors at age 45, 55, 65 and 75 years old.

The chief finding: The more risk factors – high cholesterol, uncontrolled high blood pressure, tobacco use, diabetes – people had in their 40s and 50s, the greater their risk of dying by age 80 of a heart attack or stroke. Those with the fewest risk factors in middle age “had substantially lower risks of death from cardiovascular disease through the age of 80 years than participants with two or more major risk factors,” the authors of the study wrote.

The difference was 4.7 percent vs. 29.6 for men and 6.4 percent vs. 20.5 percent for women.

In other words, the seeds of cardiovascular disease tend to be sown earlier in life than many Americans are accustomed to thinking.

The study is a marked departure from most previous studies, which usually have focused on short-term heart disease risk rather than overall lifetime risk.

It carries some big implications for how we ought to approach risk reduction in the context of cardiovascular disease. Individuals in their 40s might not view a heart attack as something they need to immediately worry about when their lifetime risk could in fact be quite high, Dr. Jarett Berry, one of the lead authors of the study, explained in an accompanying news release.

“If we want to reduce cardiovascular disease, we need to prevent the development of risk factors in the first place,” he said. “What determines your heart disease risk when you are 70 or 80 is what your risk factors are when you’re 40.”

This might sound like a “Duh!” conclusion. Fewer risk factors mean… well, lower risk, right?

The NEJM study in fact reinforces a couple of points: First, that the well-known risk factors we all talk about when it comes to heart disease – smoking, high cholesterol and so on – really do matter; second, that cardiovascular risk factors often are stealthily at work behind the scenes by early middle age. Maybe we should be thinking “the sooner the better” on reducing heart attack risk, rather than “better late than never.”

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