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Primary Prevention as an Anti-Aging Strategy - the importance of starting down the right path

 
Risk factors and chronic diseases typically get most attention among middle-age and older folks. And rightly so, since that's when the manifestations of chronic diseases start to show up, and when people get reminded about their chronological age.
 
An integral component of anti-aging (aka successful aging or healthy aging) is the freedom of physical disabilities and debilitating chronic diseases.[1-3] While it is true that it is never too late to become health conscious and reap the benefits of a healthy lifestyle [4, 5], the fact remains that the sooner we start the better off we will be as we get older.[6, 7] If you are in your 20s, 30s or early 40s, read on….
 

Attitudes and risk perceptions among young adults  

 
Adolescents and young adults often underestimate the negative consequences of their personal behaviors and habits, and have unrealistic optimism of vulnerability.[8-12] This is especially true for heart/cardiovascular disease risk.[8, 13-16] This "I am young and don't have to worry" or "it won't happen to me" attitude, however, can have serious impact on lifestyle choices and future health outcomes. 
 
This denial is putting many people at undue high risk. The Heart and Stroke Foundation found that while people are aware of the importance of addressing their risk factors, most have a false sense of security that is cutting their lives short.[17] People consistently overestimate their own healthy behaviors: 
 
Almost 90% of rate themselves as healthy. The reality is that 9 out of 10 s have at least one risk factor for heart disease and stroke. 
 
Only about a third said they are not physically active or don't eat a minimum of five servings of vegetables and fruit per day. The reality is about half don't meet the physical activity and healthy eating recommendations. 
 
18% of adults say they are obese. The reality is that almost one quarter - 25% - are obese. 
 
Among people with blood lipid abnormalities, only 35% are aware that they have it [18], and many don't even know their blood pressure.[19] This huge chasm between perception and reality can become fatal.
 

Appearances can be deceptive

 
The fact that appearances are deceptive is true in many areas in life, and most of us have experienced it first hand in social interactions. However, it is also true when it comes to risk factors for chronic diseases. 
 
While visible health risks, like body fatness, unhealthy food habits, physical inactivity, excessive alcohol consumption and smoking, are good markers for non-visible risk factors (like blood pressure, blood cholesterol/fats, diabetes, cardiovascular function), they don't always go together. It has been documented in both the lay and medical literature that even people with no visible risk factors die prematurely, and conversely that sometimes people with visible risk factors live longer than expected.[20] A study that specifically investigated these "anomalous deaths" and "unwarranted survivors" concluded that theses aberrant observations can be explained by the presence or lack of non-visible risk factors.[21] While the low visible risk status group in general lived longer than the high visible risk status group, within each group there were notable survival differences. Premature deaths in the low visible risk status group were explained by the presence of non-visible risk factors, and longer than expected survival in the high visible risk status group was due to absence of non-visible risk factors.[21]
 
The vast majority of people do not accept disease risks that are asymptomatic and not obvious.[22] This, coupled with the very high risk factor prevalence in the general public provides a good rationale to regularly do health checkups, and to start doing so at an early age.[23] The fact that risk factor control in adults and elderly reduces but doesn't eliminate disease [24] further underscores the importance of early monitoring, prevention and intervention. Therefore, even if your appearance may indicate a low risk status, it is important that you still keep track of your invisible risk parameters by doing regular blood testing and health checkups. 
 
What's especially disturbing is that even doctors often underestimate their patient's risk and are ignorant of risk factors they feel don't belong to their special medical area [25-28]. So put your foot down if your physician gives you a clean bill of health without running any comprehensive labs tests.
 

Risk factor prevalence among young adults

 
Today, very few Americans are at low risk for heart disease, the main killer.[29, 30] Approximately 78% of adults aged 20-80 years alive today in the United States are candidates for at least one prevention activity.[31] More than half of young adults have at least one cardiovascular disease risk factor, and over 37% reported having two or more [32], which greatly increases lifetime heart disease risk.[33]
 
According to the National Center for Health Statistics, nearly half of American adults have one or more of the three major risk factors: dyslipidemia (unfavorable blood cholesterol / fat profile), high blood pressure, or diabetes, and one in seven U.S. adults (15%) had one or more of these conditions undiagnosed.[34]
 
Recent updates show the following prevalence rates in US young adults: [35-37]
 
68% overweight or obese
59% abstaining from any vigorous activity
34% hypertension (high blood pressure)
32% pediatric obesity or overweight
36% pre-diabetes in adults over 20 years of age; 50% in those over 65 years of age
34% metabolic syndrome
27% undiagnosed diabetes
21.2% tobacco use 
11.2% of adults with both pre-hypertension and pre-diabetes
 
If everyone received the activities for which they are eligible, heart attacks and strokes would be reduced by 63% and 31%, respectively.[31] Of the specific prevention activities, the greatest benefits to the US population come from controlling pre-diabetes, weight reduction in obese individuals, lowering blood pressure, and improving blood lipids.[31]
 
Among young adults aged 18-39 years, only 20% meet low risk criteria, and almost 60% have high levels of at least one risk factor.[38] In young adult and middle-aged populations, aged 18 to 59 years, only 5-10% have a low health risk status.[39]
Several studies have shown that cardiovascular risk factors once documented in older adults are now appearing in young adults aged 20 to 45 years, and these young adults are developing cardiovascular disease at an alarmingly high rate.[40, 41]
 

Long lasting impact of risk factors in young adults

 
Dyslipidemia is a high risk blood lipid profile that comprises elevated levels of small dense LDL (“bad” cholesterol) particles, reduced HDL (the “good” cholesterol), and increased triglycerides (blood fats).[42]
 
To assess whether non-optimal blood lipid levels during young adulthood cause atherosclerotic changes that persist into middle age, young men and women age 18 to 30 years were followed for 20 years.[43] It was found that a whopping 87% had non-optimal baseline levels of LDL cholesterol (over 2.59 mmol/L or over 100 mg/dL), HDL cholesterol (below 1.55 mmol/L or below 60 mg/dL), or triglycerides (over 1.70 mmol/L or over 150 mg/dL) during young adulthood.[43] 

 


 

Comment:
 
It should be noted that the total LDL level per see is not good risk predictor. It is the number and size of the LDL particles that matters, not the total LDL level. For more info, see my previous article
 
The important thing to remember is that an elevated level of triglycrides combined with a reduced level of HDL indicates that there are more atherogenic LDL particles floating around, regardless of the total LDL level.[44]

 

20 years later, coronary artery calcium (i.e. calcium deposits in the heart artery wall, which is a strong predictor of future heart disease [45-47]) was measured. Of the young adults who maintained an optimal blood lipid profile, the prevalence of coronary artery calcium was only 8%, compared to 44% in participants with who did not.[43] This study shows that even moderate deviations from an optimal blood lipid profile in young adults has a significant and long-lasting impact on heart vessel  atherosclerosis 20 years later. In line with this, another study found that a range of risk factors measured before middle age were related to risk of total and cardiovascular mortality up to 40 years  later.[48]

 

 

It is not just about blood cholesterol (aka lipids and lipoproteins)

 
The strong association between coronary heart disease and unfavorable blood lipid profiles has often overshadowed the effects of the non-lipid risk factors like obesity, and diabetes, impaired glucose tolerance, high blood pressure and smoking. It has even led to questioning the importance of these risk factors in the presence of a favorable lipoprotein profile. In a study that investigated the impact of these non-lipid risk factors in young adults, 15 to 34 years of age, with optimal blood lipid profiles, it was found that all of them caused atherosclerotic lesions despite the presence of optimal blood lipid profiles.[49] A growing body of research also shows that the inflammatory marker C-reactive protein (CRP), which is a less well known risk factor, is a stronger predictor of cardiovascular events than the infamous LDL (the "bad" cholesterol)?[50-52] These findings underscores the need to test for and control all known cardiovascular risk factors.[49]
 

Bottom Line

 
Risk factor modification earlier in life has a greater impact than more significant risk reductions later in life; prevention efforts at a younger age may therefore have a lasting impact later in life. Heart disease risk in young adults aged 18–24 years is underestimated despite the high prevalence of risk factors [53-56] and early signs of atherosclerosis in this age group.[57, 58]
 
Even if you think your health is good and you aren't suffering today, don't take your current health status for granted. Many invisible risk factors can hide behind the surface. Do you really know what your blood pressure, HDL, CRP and blood sugar is? Most people don't know their invisible risk factors, as opposed to obesity, unhealthy food habits and lack of exercise, which are obvious. Make sure not to be one of them. Regular blood testing and early intervention if needed, is a prerequisite to prevent the ravages of aging and ensure a long healthy life.
 
While it is true that some of the negative effects of early life influences can effectively be overcome by current healthier behaviors [59], the way one arrives at middle age sets the stage for the years to follow [60]. And how well we fare at middle age is in turn determined by how we lived in young adulthood, and even influenced by our childhood years. 
 
Here's why you should do regular blood tests and health check-ups, even if you are young and apparently healthy:
 
- The largest killer, cardiovascular diseases, starts to develop silently early in life.
 
- There is a high prevalence of risk factors, even among young adults.
 
- Risk factors in young adults have a long lasting negative impact on health for up to 40 years later.
 
-  By doing blood testing when you are young and in good health, you will know what your optimal baseline levels are. This will serve as a good guideline for you when you get older and your levels start to deviate from your optimum. As you get older, you should strive to keep your levels as close as possible to your young baseline.
 
- Most people have a tendency to greatly underestimate their own health risks.
 
The sooner risk factors are detected and treated, and the more years of our lives that we spend engaging in healthy lifestyle behaviors, the greater our odds for aging successfully and staying vital even at old age. Don't jeopardize the quality and length of your life by living in denial; take action now by scheduling your blood work exam and start tracking your invisible risk factors. See it as an investment in your health and happiness. While there will always be exceptions, for the large majority of us there is truth in "the older you get, the healthier you have been".[61] 
 

References:

 

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38.          Daviglus, M.L., et al., Favorable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality. JAMA, 2004. 292(13): p. 1588-92.

39.          Stamler, J., et al., Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. JAMA, 1999. 282(21): p. 2012-8.

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43.          Pletcher, M.J., et al., Nonoptimal lipids commonly present in young adults and coronary calcium later in life: the CARDIA (Coronary Artery Risk Development in Young Adults) study. Ann Intern Med, 2010. 153(3): p. 137-46.

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45.          Nucifora, G., et al., Coronary artery calcium scoring in cardiovascular risk assessment. Cardiovasc Ther, 2011. 29(6): p. e43-53.

46.          Vliegenthart, R. and P.B. Morris, Computed tomography coronary artery calcium scoring: review of evidence base and cost-effectiveness in cardiovascular risk prediction. J Thorac Imaging, 2012. 27(5): p. 296-303.

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48.          Gray, L., et al., What is the predictive value of established risk factors for total and cardiovascular disease mortality when measured before middle age? Pooled analyses of two prospective cohort studies from Scotland. Eur J Cardiovasc Prev Rehabil, 2010. 17(1): p. 106-12.

49.          McGill, H.C., Jr., et al., Effects of nonlipid risk factors on atherosclerosis in youth with a favorable lipoprotein profile. Circulation, 2001. 103(11): p. 1546-50.

50.          Ridker, P.M., et al., Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med, 2002. 347(20): p. 1557-65.

51.          Salazar, J., et al., C-reactive protein: clinical and epidemiological perspectives. Cardiol Res Pract, 2014. 2014: p. 605810.

52.          Yousuf, O., et al., High-sensitivity C-reactive protein and cardiovascular disease: a resolute belief or an elusive link? J Am Coll Cardiol, 2013. 62(5): p. 397-408.

53.          Burke, J.D., et al., The University of New Hampshire's Young Adult Health Risk Screening Initiative. J Am Diet Assoc, 2009. 109(10): p. 1751-8.

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Last modified on Wednesday, 06 December 2017 21:35
Monica

Medical Writer & Nutritionist

MSc Nutrition

University of Stockholm & Karolinska Institute, Sweden 

   Baylor University, TX, USA

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