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Eur J Epidemiol. 2016 May;31(5):455-68. doi: 10.1007/s10654-015-0112-8. Epub 2016 Jan 18.

Effect of major lifestyle risk factors, independent and jointly, on life expectancy with and without cardiovascular disease: results from the Consortium on Health and Ageing Network of Cohorts in Europe and the United States (CHANCES).

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UKCRC Centre of Excellence for Public Health for Northern Ireland, Queens University Belfast, Belfast, BT12 6BA, Northern Ireland, UK.
Centre for Statistical Science and Operational Research (CenSSOR), Queen's University Belfast, Belfast, BT7 1NN, Northern Ireland, UK.
UKCRC Centre of Excellence for Public Health for Northern Ireland, Queens University Belfast, Belfast, BT12 6BA, Northern Ireland, UK.
Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark.
Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
Faculty of Medicine, University of Aalborg, Aalborg, Denmark.
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
Department of Community Medicine, University of Tromsø, 9037, Tromsø, Norway.
Department of Health, National Institute for Health and Welfare (THL), 00271, Helsinki, Finland.
The Tisch Cancer Institute and Institute for Translational Epidemiology, Mount Sinai School of Medicine, New York, NY, 10029, USA.
Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos str., 115 27, Athens, Greece.
Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Mikras Asias 75 st, 115 27, Athens, Greece.


Seldom have studies taken account of changes in lifestyle habits in the elderly, or investigated their impact on disease-free life expectancy (LE) and LE with cardiovascular disease (CVD). Using data on subjects aged 50+ years from three European cohorts (RCPH, ESTHER and Tromsø), we used multi-state Markov models to calculate the independent and joint effects of smoking, physical activity, obesity and alcohol consumption on LE with and without CVD. Men and women aged 50 years who have a favourable lifestyle (overweight but not obese, light/moderate drinker, non-smoker and participates in vigorous physical activity) lived between 7.4 (in Tromsø men) and 15.7 (in ESTHER women) years longer than those with an unfavourable lifestyle (overweight but not obese, light/moderate drinker, smoker and does not participate in physical activity). The greater part of the extra life years was in terms of "disease-free" years, though a healthy lifestyle was also associated with extra years lived after a CVD event. There are sizeable benefits to LE without CVD and also for survival after CVD onset when people favour a lifestyle characterized by salutary behaviours. Remaining a non-smoker yielded the greatest extra years in overall LE, when compared to the effects of routinely taking physical activity, being overweight but not obese, and drinking in moderation. The majority of the overall LE benefit is in disease free years. Therefore, it is important for policy makers and the public to know that prevention through maintaining a favourable lifestyle is "never too late".


Ageing; CHANCES; Cardiovascular disease; Mortality; Obesity; Smoking

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