karen-alexanderMaintaining a healthy lifestyle in our 30s, 40s or 50s is an important determinant of how we will age. New information confirms this association between lifestyle and healthy aging has no expiration date. Healthier lifestyles in our 70s and beyond continue to yield benefits as demonstrated by the Three Cities Study. In 2010, the American Heart Association released Life’s Simple 7, which is a 7-step list of ideal lifestyle modification goals that target improved cardiovascular health. AHA Life’s Simple 7 are a mix of behavioral (healthy diet, nonsmoking, moderate to vigorous physical activity more than 150 min/week) and biological (total cholesterol <200 mg/dl, blood pressure <120/80 mm Hg, fasting glucose <100 mg/dl, and body mass index <25 kg/m2) targets, with each goal having levels of ideal, intermediate, and poor attainment. Attainment of Life’s Simple 7 goals is associated with better cardiovascular health, better general health, less cancer, depression, cognitive impairment, diabetes, frailty, and all-cause mortality.

Better attainment of the American Heart Association’s Life’s Simple 7 goals among 9,294 men and women from France (mean age of 73.8 years) was associated with better health outcomes a decade later. Older adults who met at least 5 of 7 ideal goals at baseline had a 35% lower risk of all-cause mortality. Adults who met 3 to 5 ideal goals (intermediate health) had a 17% lower risk of all-cause mortality. Even better news is that outcomes improved with each goal attained; even intermediate goal attainment had a beneficial association with outcomes. Now for the bad (if predictable) news: only 1 participant met all 7 goals at ideal status, 5% met at least 5 of 7, and 15% met all behavioral goals. This attainment is comparable to similarly low rates in much younger populations around the US and world. Even though aging biology impacts non-attainment of ideal status on some measures (e.g. blood pressure and cholesterol), healthier behaviors were more likely among longer lived adults. Since healthy behaviors may prevent cognitive impairment and frailty, better goal attainment in older populations is important for optimizing survival and quality of life, while limiting time spent with illness and disability. This article has emboldened me to push my older patients to continue to shoot for Life’s Simple 7, giving few a “pass” based solely on age. Even more relevant for the older population, working to achieve these goals is likely to yield benefits before attaining ideal status. A favorite Tibetan proverb applies to those age 70 and beyond: “The secret to living well and longer is to eat half, walk double, laugh triple, and love without measure.”


By: Karen Alexander, MD