Elsevier

Preventive Medicine

Volume 41, Issue 2, August 2005, Pages 583-588
Preventive Medicine

Lifestyle still predicts mortality in older men with established vascular disease

https://doi.org/10.1016/j.ypmed.2004.12.007Get rights and content

Abstract

Background.

It is uncertain whether accepted associations between health behaviors and mortality are pertinent to elderly people. No previous studies have examined the patterns of lifestyle in elderly men with and without clinically evident vascular disease by using a lifestyle score to predict survival.

Methods.

We measured prevalence of a healthy lifestyle (four or more healthy behaviors out of eight) and examined survival in 11,745 men aged 65–83 years participating in a randomized population-based trial of screening for abdominal aortic aneurysm in Perth, Western Australia. After stratifying participants into five groups according to history and symptoms of vascular disease, we compared survival of men in each subgroup with that of ‘healthy’ men with no history or symptoms of vascular disease.

Results.

Invitations to screening produced a corrected response of 70.5%. After adjusting for age and place of birth, having an unhealthy lifestyle was associated with an increase of 20% in the likelihood of death from any cause within 5 years (95% CI: 10–30%). This pattern was consistently evident across subgroups defined by history of vascular disease, but was less evident for deaths from vascular disease.

Conclusions.

Our results highlight the importance of maintaining a healthy lifestyle through to old age, regardless of history of 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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