Aging & Longevity

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

TL;DR

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.

Key Findings

The proportion of men reaching age 90 increased progressively with the number of low-risk cardiovascular factors present in early midlife.

  • Men with zero low-risk factors had a 6.8% rate of reaching age 90, compared to 41.9% among those with all five low-risk factors.
  • Intermediate groups showed a stepwise gradient: 14.2% (one factor), 18.3% (two factors), 26.7% (three factors), and 36.6% (four factors).
  • The trend was statistically significant (P < 0.001).
  • By January 31, 2025, 2524 of 2690 men (93.8%) had died, allowing near-complete mortality ascertainment.

Men with five low-risk factors in midlife had substantially less phenotypic frailty in old age compared to those with zero low-risk factors.

  • Frailty prevalence was 2.2% in men with five low-risk factors versus 24.5% in men with zero low-risk factors at mean age 79 years.
  • This difference was statistically significant (P = 0.013).
  • Frailty was assessed at a mean age of 79 years in 2007, approximately 37 years after the midlife baseline assessment.
  • The old-age assessment included 907 surviving men, with a response rate of 63% that was similar across baseline risk groups.

Men with five low-risk factors in midlife reported greater happiness in old age compared to those with zero low-risk factors.

  • Mean happiness score was 8.0 in men with five low-risk factors versus 7.5 in men with zero low-risk factors.
  • Happiness was measured using a Cantril ladder-type 10 cm visual analogue scale.
  • The difference approached but did not reach conventional statistical significance (P = 0.053).

Men with five low-risk factors in midlife had higher psychological wellbeing in old age compared to those with zero low-risk factors.

  • 55.1% of men with five low-risk factors reported high psychological wellbeing versus 39.0% of men with zero low-risk factors.
  • This difference was statistically significant (P = 0.03).
  • Psychological wellbeing was assessed at mean age 79 years in 2007.

Men with more low-risk cardiovascular factors in midlife reported better health-related quality of life (HRQoL) across several domains in old age.

  • HRQoL was measured using the RAND-36 instrument at mean age 79 years.
  • Better HRQoL was observed in several domains among men with five low-risk factors compared to those with zero low-risk factors.
  • The specific domains showing significant differences are not enumerated in the abstract.

The study cohort consisted of healthy men born 1919–1934 with five cardiovascular low-risk factors assessed at a mean age of 42 years.

  • Total baseline sample was n = 2690 men.
  • The five low-risk factors were: non-smoking, BMI < 25 kg/m², systolic blood pressure < 140 mmHg, total cholesterol < 6.0 mmol/L, and one-hour post-load glucose < 9.0 mmol/L.
  • At baseline, 59 men had zero low-risk factors, 422 had one, 855 had two, 832 had three, 417 had four, and 105 had five low-risk factors.
  • Old-age outcomes were assessed in 2007 when survivors had a mean age of 79 years, representing a follow-up of approximately 37 years.

What This Means

This research followed over 2,600 Finnish men for roughly four decades, measuring their cardiovascular health risk factors in their early 40s and then assessing their quality of life, happiness, frailty, and wellbeing when they were around 79 years old. The five low-risk factors examined were not smoking, having a healthy body weight, normal blood pressure, healthy cholesterol levels, and normal blood sugar after a glucose load. The researchers tracked survival all the way through January 2025, by which point nearly 94% of the men had died, giving an unusually complete picture of lifelong outcomes. The study found clear, stepwise benefits associated with having more low-risk factors in midlife — not just for living longer, but for living better. Men who had all five healthy factors in midlife were more than six times as likely to reach age 90 compared to men with none of these factors (41.9% vs. 6.8%). Among those who survived to old age, men with all five low-risk factors were far less likely to be frail (2.2% vs. 24.5%), reported higher psychological wellbeing (55.1% vs. 39.0%), scored higher on happiness, and had better health-related quality of life across multiple dimensions. This research suggests that maintaining cardiovascular health in early and middle adulthood does not simply add years to life — it also adds life to those years. The findings address a common concern that healthy lifestyles might only extend the period of disability or decline, showing instead that lower cardiovascular risk in midlife is linked to better physical and mental wellbeing well into old age. Because this was an observational study of men from a specific era and country, the findings may not apply equally to women or other populations, but the consistency of the dose-response pattern across all five risk factors strengthens confidence in the association.

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Citation

T. Strandberg, A. Strandberg, K. Pitkälä, Mika Kivimäki. (2026). Low cardiovascular risk in early midlife and quality of life in old age: a life-long follow-up study in men.. European Journal of Preventive Cardiology. https://doi.org/10.1093/eurjpc/zwag429