Lifestyle still predicts mortality in older men with established vascular disease
Introduction
Encouraging people to maintain health into old age through following a prudent lifestyle is a major concern worldwide. Such a lifestyle is associated with a lower risk of an acute myocardial infarction (AMI) [1], the single commonest cause of death in many developed countries [2]. Patients with clinically evident coronary disease account for 5% of the Australian population but contribute 31% of new coronary events. Changes in their lifestyle potentially would contribute more to a reduction in such events than pharmacological treatment for high levels of blood pressure and cholesterol [3]. There is mounting evidence that such individuals can achieve and maintain such changes, especially if health professionals support them in the period immediately following a vascular event [4], [5]. Considerable reductions in incident [1] and recurrent [6] morbidity from heart disease could be seen if more people could be persuaded to adopt and maintain a healthy lifestyle.
Although there has been much research into associations between health behaviors and mortality, it is uncertain whether these associations are pertinent to elderly people [7]. Most studies have concentrated on single lifestyle behaviors, and although many have shown that a longer life is associated with maintenance of at least one healthy behavior [8], [9], [10], [11], few studies have examined the association with survival using several lifestyle factors simultaneously.
We have demonstrated the predictive power for all-cause mortality over 5 years of a lifestyle score based on eight prudent behaviors in healthy older men [12]. In this report, we examine the patterns of lifestyle in men with clinically evident vascular disease and whether this lifestyle score is also predictive of survival in such individuals.
Section snippets
Methods
The findings in this paper are based on data from a population-based trial of ultrasound screening for abdominal aortic aneurysm (AAA), the protocol and results for which are described in full elsewhere [13], [14]. An electronic copy of the Western Australian electoral roll was used to identify men living in Perth, Western Australia, who were aged 65–83 years and not resident in nursing homes. As well as undergoing an ultrasound scan, each man completed a detailed questionnaire covering his
Results
Scores were allocated for eight aspects of lifestyle with a score of 1 representing the healthy level for each. Fig. 1 shows the proportion of men in each health status group reporting a healthy response for each lifestyle behavior. For six out of the eight behaviors, the group of men with a history of stroke, claudication, or AAA had the lowest proportion of men reporting healthy responses. However, this health status group was relatively small, containing only 447 men. Fig. 2 shows the
Discussion
Two-thirds of the elderly men in the present study had a history of vascular problems or related symptoms, but a higher proportion of these had a healthy lifestyle compared with men with no vascular history or symptoms (74% vs. 63%), probably because individuals with clinically evident vascular disease adjust their lifestyles in a healthy direction as a result of their diagnosis. The healthy behavior of the men with a vascular history was reassuring since there are concerns that the immediate
Acknowledgments
The Western Australian Abdominal Aortic Aneurysm Program is supported by a grants-in-aid from the National Health and Medical Research Council and the National Heart Foundation of Australia. The authors are also grateful for assistance received from the State Electoral Commission, the Australian Bureau of Statistics, the Registrar General of Births, Deaths and Marriages, and the Health Department of Western Australia to hospitals in Perth for providing space in which to conduct screening. We
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