HEALTHY AGEING

Better than any pill… and no side effects!

The benefits of a healthy lifestyle

Peter Elwood

Cochrane Institute of Primary Care and Public Health

EVIDENCE FROM WALES:

The Caerphilly Cohort Study

EVIDENCE FROM a representative population Welsh sample:

THE CAERPHILLY PROSPECTIVE STUDY 1979……

2,500 men aged 45-59 yrs; 90% response rate

The Caerphilly Cohort Study

EVIDENCE FROM WALES:

THE CAERPHILLY PROSPECTIVE STUDY 1979……

2,500 men aged 45-59 yrs; 90% response rate

questioned and re-examined every five years since baseline

The Caerphilly Cohort Study

EVIDENCE FROM WALES:

THE CAERPHILLY PROSPECTIVE STUDY 1979……

2,500 men aged 45-59 yrs; 90% response rate

questioned and re-examined every five years since baseline

INCIDENT DISEASE during the following 35 years

Detailed clinical data collected from primary care and hospital records

and standard diagnostic criteria applied.

The Caerphilly Cohort Study

EVIDENCE FROM WALES:

Over 400 papers published

initially on factors relevant to ischaemic heart disease,

then ischaemic stroke and diabetes,

then other diseases, cognitive decline and dementia….

The Caerphilly Cohort Study

EVIDENCE FROM WALES:

Over 400 papers published

initially on factors relevant to ischaemic heart disease,

then ischaemic stroke and diabetes,

then other diseases, cognitive decline and dementia……..

healthy behaviours and reductions in disease

The Caerphilly Cohort Study

The five

healthy behaviours

The five ‘Healthy behaviours’ Non smoking

A low body weight - BMI 18-25

Activity - ½ hour walking five+ days per week

A plant-based diet – ‘five a day’ fruit and veg.

Low alcohol - consumption within the guidelines

Healthy ageing

The five healthy

behaviours…..

- non-smoking

- a low body weight

- regular exercise

- a healthy diet

- a low alcohol intake

Healthy ageing

UNHEALTHY LIFESTYLE

None or one behaviour

HEALTHY LIFESTYLE

Four or five behaviours

The five healthy

behaviours…..

- non-smoking,

- a low body weight

- regular exercise

- a healthy diet

- a low alcohol intake

Healthy ageing

- Diabetes

- Heart disease & stroke

- Cancer

- Dementia

and

incident disease

Detailed clinical data collected from primary care and hospital records and

standard diagnostic criteria applied.

HEALTHY

BEHAVIOURS Diabetes

Vasc. disease

Cancer

Dementia

‘Unhealthy’ (None or one

healthy behaviour)

Any two

Any three

‘Healthy’ (Four or five healthy

behaviours)

100

100

100

100

REDUCTIONS*

* Reductions based on Odds Ratios, adjusted for age, social class,

and, for dementia, a base-line cognitive function test (NART)

HEALTHY

BEHAVIOURS* Diabetes

Vasc. disease

Cancer

Dementia

‘Unhealthy’ (None or one

healthy behaviour)

Any two

Any three

‘Healthy’ (Four or five healthy

behaviours)

100

100

100

100

REDUCTIONS

- This presentation is limited to men whose lifestyles were consistent

- The dietary criterion had to be reduced to three portions of fruit & veg/day

HEALTHY

BEHAVIOURS*

Diabetes Vascular

disease

Cancer

Dementia

‘Unhealthy’ (None or one

healthy behaviour)

Any two

Any three

‘Healthy’ (Four or five healthy

behaviours)

100

-35%

-66%

-72%

100

-17%

-34%

-67%

100

-3%

-5%

-35 %

100

-39%

-68%

-64%

REDUCTIONS**

* Confined to men who followed the behaviours consistently **Reductions based on odds ratios and adjusted for age and social class and for dementia, a base-line cognitive function test

HEALTHY

BEHAVIOURS Diabetes

214 men

Vasc. Disease

752 men

Cancer

648 men

Dementia

121 men

‘Unhealthy’ (None or one

healthy behaviour)

Any two

Any three

‘Healthy’ (Four or five healthy

behaviours)

100

-35%

-66%

-72%

100

-17%

-34%

-67%

100

-3%

-5%

-35 %

100

-39%

-68%

-64%

REDUCTIONS

* Confined to men who followed the behaviours consistently **Reductions based on odds ratios and adjusted for age and social class

and for dementia, a base-line cognitive function test

HEALTHY

BEHAVIOURS*

Diabetes

Vascular

disease

Cancer

Dementia

‘Unhealthy’ (None or one

healthy behaviour)

Any two

Any three

‘Healthy’ (Four or five healthy

behaviours)

100

-35%

-66%

-72%

100

-17%

-34%

-67%

100

-3%

-5%

-35 %

100

-39%

-68%

-64%

Significance of trend 0.001 0.0005 0.88 0.02

REDUCTIONS

* Confined to men who followed the behaviours consistently **Reductions based on odds ratios and adjusted for age and social class and for dementia, a base-line cognitive function test

HEALTHY

BEHAVIOURS*

Diabetes Vascular

disease

Cancer

Dementia

‘Unhealthy’ (None or one

healthy behaviour)

Any two

Any three

‘Healthy’ (Four or five healthy

behaviours)

100

-35%

-66%

-72%

100

-17%

-34%

-67%

100

-3%

-5%

-35 %

100

-39%

-68%

-64%

Significance of trend 0.001 0.0005 0.88 0.02

REDUCTIONS

In the 85,000 women in the US WHS, 61% reduction in type 2 diabetes

was attributable to a low BMI alone. Hu et al. N Engl J Med 2001; 345:790-7.

In Caerphilly 69% of diabetes was attributable to a low BMI alone..

HEALTHY

BEHAVIOURS*

Diabetes Vascular

disease

Cancer

Dementia

‘Unhealthy’ (None or one

healthy behaviour)

Any two

Any three

‘Healthy’ (Four or five healthy

behaviours)

100

-35%

-66%

-72%

100

-17%

-34%

-67%

100

-3%

-5%

-35 %

100

-39%

-68%

-64%

Significance of trend 0.001 0.0005 0.88 0.02

REDUCTIONS

US Health Professionals who had adopted the five healthy behaviours experienced

an 87% reduction in heart disease (RR: 0.13 CI: 0.09-0.19) [Circulation 2006;114:160-7]

The 84,000 women in the US Nurses’ Health Study the risk of coronary events

was reduced 85% (RR: 0.17; 95% CI: 0.07-0.41) by following the five behaviours

[Stampfer et al. N Engl J Med 2000;343:16-22]

In a study of 4,886 British adults, following four healthy behaviours led to a

reduction of 70% (HR 0.29; 95% CI: 0.19, 0.43) for cardiovascular disease. [Kvaavik et al. E.

Arch Intern Med 170: 711-8]

HEALTHY

BEHAVIOURS*

Diabetes Vascular

disease

Cancer

Dementia

‘Unhealthy’ (None or one

healthy behaviour)

Any two

Any three

‘Healthy’ (Four or five healthy

behaviours)

100

-35%

-66%

-72%

100

-17%

-34%

-67%

100

-3%

-5%

-35 %

100

-39%

-68%

-64%

Significance of trend 0.001 0.0005 0.88 0.02

REDUCTIONS

In some studies the reduction in cancer is large, up to about 70% (HR 0.30 95% CI: 0.15,

0.60) [Ford et al. Arch Intern Med 169: 1355-1362. ]

In 112,000 non-smoking subjects, subjects with a healthy lifestyle showed a

reduction of 14% in incident cancer (RR: 0.86; 95% CI: 0.78, 0.94) [McCullough et al. Cancer

Epidemiol Biomarkers Prev 20: 1089-1097. ]

HEALTHY

BEHAVIOURS*

Diabetes Vascular

disease

Cancer

Dementia

‘Unhealthy’ (None or one

healthy behaviour)

Any two

Any three

‘Healthy’ (Four or five healthy

behaviours)

100

-35%

-66%

-72%

100

-17%

-34%

-67%

100

-3%

-5%

-35 %

100

-39%

-68%

-64%

Significance of trend 0.001 0.0005 0.88 0.02

REDUCTIONS

In the Honolulu-Asia Aging Study a healthy lifestyle was related to a

64% reduction in dementia (OR 0.36, 95 % CI 0.15, 0.84) [J Am Geriatr Soc 60: 118-123. ]

Several studies, including the Whitehall cohort, have reported associations

in cognitive function. [Br J Psychiatry 203:120-5 and Neurology 79: 755-62]

Men with

‘Consistent’

Lifestyles Diabetes

214 men

Vasc, disease

752 men

Cancer

648 men

Dementia

121 men

‘Unhealthy’

None or one behaviour

‘Healthy’ Four or five behaviours

100

-72%

100

-67%

100

-35 %

100

-64%

Significance of trend 0.001 0.0005 0.88 0.02

REDUCTIONS

US Health Professionals who had adopted the five healthy behaviours experienced an 87% reduction in heart

disease (Relative risk (RR): 0.13 CI: 0.09-0.19) [Chiuve et al. Circulation 2006;114:160-7]

The 84,000 women in the US Nurses’ Health Study the risk of coronary events was reduced 85% (RR: 0.17; 95%

CI: 0.07-0.41) by following the five behaviours [Stampfer et al. N Engl J Med 2000;343:16-22] .

In a study of 4,886 adult British subjects, the following of four healthy behaviours led to hazard ratios of 0.29 (95%

CI: 0.19, 0.43) for cardiovascular disease. [Kvaavik et al. E. Arch Intern Med 170: 711-8]

in some studies the reduction in cancer is large, up to a hazard ratio of 0.30 (95% CI: 0.15, 0.60) [Ford et al. Arch

Intern Med 169: 1355-1362. ]

In another. 112,000 non-smoking subjects, the 4% of subjects who achieved a high score based on body weight,

activity, diet and alcohol intake, showed a reduction of only 14% in incident cancer (RR: 0.86; 95% CI: 0.78,

0.94) [McCullough et al. Cancer Epidemiol Biomarkers Prev 20: 1089-1097]

In the Honolulu-Asia Aging Study a healthy lifestyle was related to reduced risk of dementia over 25 years

(OR 0.36, 95 % CI 0.15, 0.84) [Gelber et al. J Am Geriatr Soc 60: 118-123. ]

Within the Whitehall study obesity, alcohol and smoking have been show to affect cognitive decline over 10 yrs

[Hagger-Johnson et al. Br J Psychiatry 203: 120-5; Singh-Manoux et al. Neurology 79: 755-62]

Men with

‘Consistent’

Lifestyles Diabetes

214 men

Vasc, disease

752 men

Cancer

648 men

Dementia

121 men

‘Unhealthy’

None or one behaviour

‘Healthy’ Four or five behaviours

100

-72%

100

-67%

100

-35 %

100

-64%

Significance of trend 0.001 0.0005 0.88 0.02

REDUCTIONS

Better than any drug….

and no side effects!

1,023

‘CONSISTENT’

Men** Diabetes Vascular

disease

Cancer Dementia

‘Unhealthy’

‘Healthy’

100

-72%

100

-67%

100

-35 %**

100

-64% Significance of trend 0.001 0.0005 0.88 0.02

REDUCTIONS

BENEFITS OF A HEALTHY LIFESTYLE:

1. Reductions in incident disease:

- up to 70% less diabetes

- up to 60% less heart disease and stroke

- up to 35% less cancer

- up to 60% less dementia

1,023

‘CONSISTENT’

Men** Diabetes Vascular

disease

Cancer Dementia

‘Unhealthy’

‘Healthy’

100

-72%

100

-67%

100

-35 %**

100

-64% Significance of trend 0.001 0.0005 0.88 0.02

REDUCTIONS

BENEFITS OF A HEALTHY LIFESTYLE:

1. Reductions in incident disease

2. Delayed onset of disease (rate advancement):

- vascular disease events delayed by up to 13 years

- dementia delayed by up to 6 years

- death from any cause by up to 6 years

1,023

‘CONSISTENT’

Men** Diabetes Vascular

disease

Cancer Dementia

‘Unhealthy’

‘Healthy’

100

-72%

100

-67%

100

-35 %**

100

-64% Significance of trend 0.001 0.0005 0.88 0.02

REDUCTIONS

BENEFITS OF A HEALTHY LIFESTYLE:

1. Reductions in incident disease

2. Delayed onset of disease

3. Disease burden in the community reduced

1,023

‘CONSISTENT’

Men** Diabetes Vascular

disease

Cancer Dementia

‘Unhealthy’

‘Healthy’

100

-72%

100

-67%

100

-35 %**

100

-64% Significance of trend 0.001 0.0005 0.88 0.02

REDUCTIONS

BENEFITS OF A HEALTHY LIFESTYLE:

1. Reductions in incident disease

2. Delayed onset of disease

3. Disease burden in the community reduced

- if the subjects in the Caerphilly cohort had each been urged to take up one additional healthy behaviour….

1,023

‘CONSISTENT’

Men** Diabetes Vascular

disease

Cancer Dementia

‘Unhealthy’

‘Healthy’

100

-72%

100

-67%

100

-35 %**

100

-64% Significance of trend 0.001 0.0005 0.88 0.02

REDUCTIONS

BENEFITS OF A HEALTHY LIFESTYLE:

1. Reductions in incident disease

2. Delayed onset of disease

3. Disease burden in the community reduced - if the subjects in the Caerphilly cohort had each been urged

to take up one additional healthy behaviour….

If only half had done so, there would have been…..

12% less diabetes 6% less vascular disease 13% less dementia

1,023

‘CONSISTENT’

Men** Diabetes Vascular

disease

Cancer Dementia

‘Unhealthy’

‘Healthy’

100

-72%

100

-67%

100

-35 %**

100

-64% Significance of trend 0.001 0.0005 0.88 0.02

REDUCTIONS

BENEFITS OF A HEALTHY LIFESTYLE:

1. Reductions in incident disease

2. Delayed onset of disease

3. Disease burden in the community reduced - if the subjects in the Caerphilly cohort had each been urged

to take up one additional healthy behaviour….

If half had done so, there would have been…..

12% less diabetes equivalent, across Wales, to £23M/yr 6% less vascular disease £10M/yr 13% less dementia £27M/yr

http://wales.gov.uk/statistics-and-research/nhs-expenditure-programme-budgets/?lang=en

The uptake of a healthy lifestyle

The uptake of a healthy lifestyle

Lifestyle

Men 45-59 yrs

in Caerphilly

1979

UNHEALTHY None or one

healthy behaviour

HEALTHY Four or five healthy

behaviours

40%

8%

The Welsh Health Survey

An interview survey of

15,000 people across Wales

each year (2009-2013)

The Welsh Health Survey

Lifestyle

Men 45-59 yrs

in Wales

1979

Men 45-59 yrs

in Wales

2013

UNHEALTHY None or one

healthy behaviour

HEALTHY Four or five healthy

behaviours

40%

8%

41%

5%

The Welsh Health Survey

Lifestyle

All adults

in Wales

2013

UNHEALTHY None or one

healthy behaviour

HEALTHY Four or five healthy behaviours

44%

5%

A wake-up call to Wales

A wake-up call to Wales

“The NHS and others must do all we can to

create the conditions in which people are able

to protect their health,

but people – individuals, communities,

families across Wales - must also face

up to the challenge.”

Professor Mark Drakeford AM

Minister for Health and Social Security

A wake-up call to Wales

The challenge from Caerphilly:

‘Take up one additional healthy behaviour’

…there will be…. - reductions in disease

- delays in the onset of disease

- disease burden in the community reduced - large NHS savings