Low cardiovascular risk in early midlife and quality of life in old age: a life-long follow-up study in men.

AIMS: Few life-long studies have addressed the common question: 'Healthy lifestyles add years to life, but do they add life to years?' We examined how low cardiovascular risk in early midlife is associated with frailty, quality of life, happiness, and well-being in old age. METHODS AND RESULTS: At mean age of 42 years, five low-risk factors (non-smoking, BMI < 25 kg/m2, systolic blood pressure < 140 mmHg, total cholesterol < 6.0 mmol/L, one-hour post-load glucose < 9.0 mmol/L) were measured among healthy men born 1919-1934 (n = 2690). Phenotypic frailty, health-related quality of life (HRQoL, RAND-36), psychological wellbeing, and feeling of happiness (a Cantril ladder-type 10 cm visual analogue scale) were assessed in 2007 at a mean age of 79 years. Mortality was retrieved from national registers through 31 January 2025 (2524 men [93.8%] died). At baseline, 59 men had zero, 422 one, 855 two, 832 three, 417 four and 105 five low-risk factors. The proportion reaching 90 years increased accordingly: 6.8%, 14.2%, 18.3%, 26.7%, 36.6%, and 41.9% (P < 0.001). At mean age of 79 years (n = 907, response rate 63% and similar in baseline groups), compared to those with no low-risk factors in midlife, men with five factors had less frailty (2.2 vs. 24.5%, P = 0.013), reported greater happiness (8.0 vs. 7.5; P = 0.053), higher psychological wellbeing (55.1% vs. 39.0%, P = 0.03), and better HRQoL in several domains. CONCLUSION: Low cardiovascular risk in early midlife was associated with greater longevity, less frailty, better quality of life, and higher levels of happiness and well-being in old age.