Thought Leadership in Action

Some people balk at the suggestion of changing their lifestyles as they approach middle age. After all, the argument goes, if they’ve been sedentary and overweight for years, the damage to their bodies is probably done and it’s too late to make up for decades of unhealthy choices. But a new Northwestern Medicine study by scientists at the Northwestern University Feinberg School of Medicine shows that attitude is a myth — and a potentially dangerous one — especially when it comes to heart disease.

It turns out that when adults in their 30s and 40s give up unhealthy habits and begin to live a healthier lifestyle they not only can reduce their risk of heart attack, but the Northwestern Medicine research shows they can control and potentially even reverse the natural progression of coronary artery disease.

In their paper, recently published in the journal Circulation, the scientists note that the heart is far more forgiving than many people think, especially when it comes to adults who actively take charge of their health. This is especially important information when you consider that heart disease in the cause of 1 in every 4 deaths in the U.S., according to statistics from the Centers for Disease Control (CDC). In all, about 600,000 people die of heart disease in this country every year, making it the leading cause of death for both men and women.

The power of Healthy Lifestyles

For their research, the scientists studied healthy lifestyle behaviors and documented signs of heart disease — coronary artery calcification and thickening — among more than 5,000 participants in the Coronary Artery Risk Development in Young Adults (CARDIA). Volunteers for this study were first assessed when participants were between the ages of 18 to 30. They were assessed again, 20 years later. The healthy lifestyle factors studied including not being overweight or obese, being a nonsmoker, being physically active, having low alcohol intake and eating a healthy diet.

By young adulthood, at the beginning of the study, less than 10% of the CARDIA participants reported they had all 5 healthy lifestyle behaviors but after 20 years, about 25% of the research subjects had added at least one healthier lifestyle behavior. The researchers found that for each increase in healthy lifestyle factors, the odds of detectable coronary artery calcification and lower intima-media thickness (the two major markers of cardiovascular disease that can predict future cardiovascular events) were significantly reduced.

"This finding is important because it helps to debunk two myths held by some health care professionals," said Bonnie Spring, M.D., lead investigator of the study and a professor of preventive medicine at Northwestern University Feinberg School of Medicine. "The first is that it's nearly impossible to change patients' behaviors. Yet, we found that 25% of adults made healthy lifestyle changes on their own. The second myth is that the damage has already been done — adulthood is too late for healthy lifestyle changes to reduce the risk of developing coronary artery disease. Clearly, that's incorrect. Adulthood is not too late for healthy behavior changes to help the heart."

The Danger of Continuing Bad Habits

The study had bad news, however, for those who continue their bad habits such as overeating and smoking or giving up exercising as they grow older. The scientists found that dropping healthy habits or continuing with bad habits had a measurable, detrimental impact on the coronary arteries. “If you don't keep up a healthy lifestyle, you'll see the evidence in terms of your risk of heart disease," Dr. Spring explained.

In fact, about 40% of the people studied who lost healthy lifestyle factors and acquired more bad habits as they aged raised their risk of heart events. "That loss of healthy habits had a measurable negative impact on their coronary arteries. Each decrease in healthy lifestyle factors led to greater odds of detectable coronary artery calcification and higher intima-media thickness,” Dr. Spring said. “Adulthood isn't a 'safe period' when one can abandon healthy habits without doing damage to the heart. A healthy lifestyle requires upkeep to be maintained." She added that it is not too late for adults who have acquired some bad habits if they will start making changes and opting for a healthy lifestyle to benefit heart health.

Tips from the Northwestern University research team for embracing a healthy lifestyle at any age:

• Keep a healthy body weight
• Don't start smoking and, if you do smoke, quit
• Engage in at least 30 minutes of moderate to vigorous activity five times each week
• Don’t drink more than one alcoholic drink a day if you are a woman; men should drink no more than two alcoholic beverages daily
• Eat a healthy diet that is high in fiber, low in sodium and contains an abundance of fruit and vegetables