Can we make the date that you get sick much later—much closer to the time you’re going to die—so that you have more healthy years, not just more years, period?
We don’t seem to necessarily be doing what the science suggests, as a society. Why is that?
The truth is, although we’ve known that for 60 years, we’re still terrible at implementing it in public-health policies and in clinical practice. It’s a pretty simple message, but we don’t design our society, our environment, our neighborhoods, or our food supply to optimize those things.
It is possible to take this information and make a change. Great story: In the early 70s, Finland had the highest coronary heart disease death rates in the world, by a fair amount. They took information from Framingham and they said, You know what, let’s design a study where we take a county with particularly high coronary disease death rates and we just make some public-health changes. We’re going to implement smoking policy changes. We’re going to help people quit. We’re going to stop subsidizing meat, and we’re going to start subsidizing fruits and vegetables in our food supply.
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Immediately, the rates of coronary heart disease started to fall, and the strategies were soon applied across the country. By 30 years later, there was an 84% decline in coronary disease death rates, and suddenly Finland has the lowest coronary disease death rates in the world—so going from last to first.
In the U.S., we saw about a 70% decline in death rates from heart disease between 1968 and 2010, because we’ve gotten better clinically, and we’ve done some things with public health.
Unfortunately, I think while we were making really, really great progress, the obesity epidemic has started to really kick in on the burden of cardiovascular diseases. Because obesity will drive higher blood pressure, higher blood sugar, more adverse cholesterol levels—all sorts of things—that sort of becomes a perfect storm. Since 2011, we’ve now seen leveling off of those improvements in death rates and maybe even some reversal, which is unfortunate. We understand everything we need to know about preventing cardiovascular disease. As we actually implement that, we’ll expand healthy aging.
What does the future hold for the Framingham Heart Study?
Well, you may have heard that funding for science is a little difficult these days. But my hope would be that we would continue to represent the town of Framingham. I think there could be real value also for enrolling our fourth and our fifth generation.
The more we’ve studied the life course of all these chronic diseases, the more we’ve understood that every time we get a diagnosis, the horse is already partly out of the barn, if not all the way. So we need to get much, much earlier in the life course with prevention.
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I’ll leave you something hopeful. In another community-based study—a kind of descendant of the Framingham Heart Study—when they looked at how long people lived without cardiovascular disease, they found that lifestyle wins. Even people with high-risk genes, if they have a good lifestyle, they on average live 12 years longer than people with good genes but poor lifestyle habits. What’s more, they live 19 years longer on average without cardiovascular disease.
They not only extended their lifespan; they extended their healthspan substantially.
Genetics are not destiny. We can actually bend that curve, and people can do better if they can pursue these healthy lifestyle options. So much of this is actually in our control. But we need help: We need help from our food supply. We need help from good public-health policies so we are not exposed to indoor air that is contaminated by cigarette smoke. We need safe streets to go out and do physical activity. We need to actually be able to afford to buy fruits and vegetables.
A lot of this is policy that sets the stage. But there’s a lot in our control as well.
This article is part of TIME Longevity, an editorial platform dedicated to exploring how and why people are living longer and what this means for individuals, institutions, and the future of society. For other articles on this topic, click here.