Families that incorporate a list of seven simple health behaviors into their lifestyles can ward off not only heart disease, but also cognitive impairment, including Alzheimer's, experts say. Starting when families are young provides the best chance that clan members will be able to enjoy health benefits that extend into old age.
"Family is the perfect environment in which to promote health in terms of the American Heart Association's 'Life's Simple 7,'" said Evan Thacker, an assistant professor of health at Brigham Young University who last week unveiled research showing that taking care of your heart offers protection against cognitive decline, too.
The American Heart Association and the American Stroke Association have been promoting the "Simple 7" list that includes not smoking, eating a healthy diet, getting adequate physical activity, knowing your body mass index and keeping it in the healthy range, controlling blood pressure and maintaining both healthy cholesterol and fasting glucose levels.
That list, said Thacker, was developed "because lots of research showed if you do those seven things, there's very low risk of death from cardiovascular disease, including heart attack and stroke."
A 2012 Marist Institute for Public Opinion survey found that Americans are more afraid of developing Alzheimer's than any other disease.
Brigham Young University Department of Health Science's latest study, completed with help from University of Alabama at Birmingham's School of Public Health researchers, found that taking care of heart health extends benefits to brain health — specifically preventing cognitive decline, including dementia.
"Our study is a step toward understanding the link between heart health and dementia, Thacker said. "Every element in our body is connected and keeping one part of it healthy helps keep other parts healthy."
"There's increasing evidence that lifestyle factors have been linked to development of Alzheimer's disease," said Dr. Olajide A. Williams, director of acute stroke services at Columbia University, who was not involved in the study. "In a way, that's a good thing, because it puts certain things under our control. There's a famous saying: 'Genetics loads the cannon, but human behavior pulls the trigger.' In the early days of Alzheimer's, we were not really sure whether there were any potentially modifiable risk factors."
Evidence is mounting, he said, that "a signficant amount of the risk is in our own control." Some observational studies have estimated that preventable risk factors account for nearly half of the Alzheimer's risk.
"The challenge is that just as with heart disease and stroke, prevention requires a lot of commitment at the family and individual level," he said. "It requires you to take control."
Nuts and bolts
The researchers scored subjects' cardiovascular health based on the "Life's Simple 7" factors, each known to lower risk of cardiovascular disease.
More than 17,750 people 45 and older who showed no cognitive decline and had never suffered a stroke were divided into high, middle or low cardiovascular health categories. Researchers then tied that data to mental function scores from four years later, which were based on a series of tests such as learning a list of words and recalling them a few minutes later, seeing how many members of a common category like animals one could come up with in a minute, and others.
The data came from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study. That data was used earlier in different research to note modest increased risk of stroke for those who are inactive.
In their new study, BYU researchers found those with low cardiovascular health were almost twice as likely to show cognitive impairment — including "learning, memory and verbal fluency," they said in a written statement — as those who were heart healthy, 4.6 percent compared to the 2.6 percent for those with the best health scores.
Though those percentages are small, they equal a significant number of people, Thacker said. He noted that among the elderly, dementias are quite common, even if people are otherwise generally healthy. The Alzheimer's Association estimates 5.2 million Americans have Alzheimer's disease right now, including about 200,000 people who developed early onset disease before age 65. Direct costs of the disease are estimated at $214 billion a year.
Sooner, not later
"Even when ideal cardiovascular health is not achieved, intermediate levels of cardiovascular health are preferable to low levels for better cognitive function," Thacker said in a written statement accompanying the study. "This is an encouraging message because intermediate health is a more realistic target for many individuals.
"Anyone can choose any of those seven factors to improve on today," he told the Deseret News, suggesting individuals and families can then build on that achievement.
Healthy behaviors, Williams said, ameliorate the risk of developing cognitive decline. The evidence, while largely observational, is both convincing and increasing. "The earlier healthy habits are inculcated, the more likely an individual is to maintain those healthy habits. There is more evidence that targeting healthy habits of children before they are teenagers and adolescents, reducing obesity early in life, along with all the risk factors that go along with it, really predicts a healthier cardiovascular and weight profile in the future.
"If you make sure that kids do simple things like eat a healthy diet and are physically active — and make sure that they enjoy it and have fun doing it — it predicts greater health later in life," Williams said.
The "Simple 7":
- Kick smoking. Smoking increases risk of heart disease, aneurysms, lung disease, hardened arteries and stroke, according to the Centers for Disease Control and Prevention.
- Eat a healthy diet. Federal health experts say fruits and vegetables should fill half your plate, while whole grains and protein each take up a quarter.
- Get regular physical activity. The official recommendation is 150 minutes of moderate exercise. That's 30 minutes five days a week.
- Know your body mass index. A calculation of weight in relation to height, BMI should be below 25. You can find a simple BMI calculator on the CDC site.
- Track your blood pressure. Blood pressure should be below 120/80. Good diet, exercise, not smoking and controlling weight all help.
- Decrease your cholesterol. Total cholesterol should be below 200. The body makes most of it, but diet also contributes. It can lead to blocked arteries and other serious problems.
- Get a fasting blood sugar test. Fasting glucose should be below 100. Above that indicates pre-diabetes or diabetes.
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