The quest for quality of life and longevity is front and center in the medical and fitness communities and is the Holy Grail for all of us! This article published in the September 2022 issue of the journal Menopause focuses on the factors that impact longevity in 1158 mid-life women in Chile who were followed for a 30-year period!  This article is summarized below with my personal and professional analysis to follow. 
Enjoy! 
-Carla DiGirolamo, MD

Health screening of middle-aged women: what factors impact longevity?

Blümel, Juan E.; Aedo, Sócrates; Murray, Nigel; Vallejo, María S.; Chedraui, Peter

Menopause. 29(9):1008-1013, September 2022.

Goal of the Study

The goal of this study was to measure the impact of various risk factors on longevity in middle-aged women over a 30-year period.

Type of Study

This was a prospective cohort study (a study where a group of individuals is followed over time) of 1158 female public service officials in Chile who were followed for 30 years.

Methods

The following characteristics were defined at the start of the study:

• Age

• Body mass index (BMI)

• Postmenopausal status

• Type 2 diabetes

• Arterial hypertension (chronically elevated systolic blood pressure - the top number!)

• Cigarette use

• Physical activity (walks >1 hour/day)

• Active sexual intercourse

• Parity (having birthed one or more children)

• Unskilled job (not requiring higher or technical education)

• Personal history of fracture or heart disease

• Lipid levels (total cholesterol, HDL, LDL, Triglycerides)

At the end of the 30 years, the registry was reviewed for whether participants were living or dead, if dead, cause of death, and date of death.

Results

• Average age at the time of admission into the study was 47.4 years with an average BMI of 26 +/- 4.

• Total survival over the 30-year follow-up period was 75.6%.

• Top 3 causes of death: cancer (33.8%), cardiovascular disease (21.2%), infectious disease (15.8%).

An important point made by the authors was the concept of association vs causation. There were a number of variables associated with higher mortality at the end of the 30-year follow-up period: higher BMI, older age, postmenopausal status at the time of entry into the study, history of diabetes or arterial hypertension, and elevated triglycerides. This simply means that these factors were found more often in those who were deceased at the end of the 30-year period as compared to those who were still alive.

The authors went further using a thorough and statistically validated flexible parametric (FP) survival model to identify variables that could predict future mortality, thus implying a causative relationship between those variables and the risk of death:

• Personal history of fracture

• Type 2 diabetes mellitus

• Personal history of heart disease

• Chronic arterial hypertension

• Postmenopausal status

• Unskilled job

• Cigarette smoking

• Older age

• Higher BMI

The most notable finding of the study was that a history of fracture in women <age 60 was the risk factor that most decreased life expectancy - exceeding diabetes and hypertension.

• The FP survival model identified parity and active sexual intercourse correlated with longevity at a level of statistical significance.

• Obesity is an independent risk factor for death but decreases with age implying that it plays more of a role in the mortality risk in younger women than in older women.

• The lipid profile did not serve as a predictor for mortality.

Author’s Conclusions

Most of the known risk factors for mortality were present. However, a history of fracture, particularly when present in younger women, is a strong predictor of mortality surpassing diabetes mellitus and chronic hypertension. Multiparity and sexual activity were protective factors.

In My Humble Opinion….

The strengths of this study were the rigorous statistical analysis of variables and the long duration of follow-up of the participants. Using the Civil Registry of the Chilean government ensured accurate and complete documentation of death and associated causes.

This study illustrates the impact of fracture history - particularly in younger women - on mortality. This finding underscores the well-known correlation of fracture with poor health outcomes and a decline in quality of life.

However, caution must be exercised when extrapolating these results to other populations. For example, the average BMI of the participants of this study was 26 +/- 4. According to the National Center for Health Statistics, 42.4% of American women and men age 20 and older have a BMI of 30 or higher. This percentage is likely even higher in the middle-aged population that this study represents. One could speculate that in America, the impact of cardiovascular disease and diabetes mellitus may play an even greater role in mortality than what was reported in this study.

I find it interesting that physical activity was defined as “walking >1 hour per day”. Given their findings, it seems that further stratifying those individuals who actually “exercised” intentionally may have yielded some interesting results. Sadly, this is the status quo in many studies looking at quality of life, health outcomes, and longevity.

As a strong believer that evolution is the tool by which Mother Nature has designed the continued existence of living things since their inception on planet Earth, I find it philosophically interesting (and not surprising) that procreative fitness correlates significantly with survival.

So where does this leave us?

• Take care of those bones! Especially if you are a leaner individual such as those represented in this study.

  • Sound nutrition with plenty of protein!

  • Physical activity and exercise - maximize muscle mass and mobility

  • Prevent falls with physical fitness!

• Maintain a healthy weight, sound nutrition, and exercise strategies to promote cardiovascular health and minimize the risk of diabetes mellitus.

It’s important to realize and accept that there are always variables that are beyond our control such as age and menopausal status. However, focusing on the things we can control will help us to live the best lives we possibly can!