Favorable Cardiovascular Health and the Compression of Morbidity in Older Age

描述（由申请人提供）：已证明中年期间心血管（CV）健康状况良好（即所有主要心血管风险因素（包括血压、胆固醇、体重指数、不吸烟和未诊断出糖尿病）处于理想水平）的个体，其心血管疾病的终生风险较低，寿命较长。既往关于具有良好CV特征的获益的研究分别检查了发病率和死亡率等结局。到目前为止，尚不清楚其他疾病是否简单地取代了CVD，或者CV健康状况良好的个体是否实际上延长了健康寿命（即没有重大发病率）。虽然我们知道良好的心血管健康状况可以延迟心血管疾病的发作并延长寿命，但其对累积终身发病率的影响仍然未知。本提案的首要目标是了解年轻和中年人的心血管健康如何能够实现延长健康生活时间和减少老年人发病率（所有主要慢性疾病）的终身负担的目标。为了实现这一目标，我们将利用芝加哥心脏检测项目行业研究（CHA; 39,522名男性和女性在1967-1973年筛选）与医疗保险索赔数据到2010年的联系，这将为我们提供超过25年的随访。然后，我们将使用复杂的统计方法来解决以下具体目标。具体目标：1。确定年轻和中年人良好的心血管健康是否与死亡前较短时间内CVD发病率的压缩和/或老年人CVD发病率的平均水平较低相关。确定年轻和中年人良好的心血管健康是否与死亡前较短时间内的发病率压缩和/或老年人较低的平均发病率水平（来自所有主要慢性疾病）相关。确定中年期间良好的心血管健康是否与较低的累积、年度和生命末期医疗保险支出相关。

DESCRIPTION (provided by applicant): Individuals with favorable cardiovascular (CV) health, (i.e. having ideal levels of all major cardiovascular risk factors, including blood pressure, cholesterol, body mass index, not smoking and no diagnosis of diabetes), during middle-age have been shown to have a lower lifetime risk for cardiovascular disease and a longer lifespan. Previous studies on the benefits of a having a favorable CV profile have examined outcomes such as morbidity and mortality separately. As yet, it remains unclear whether other morbid conditions simply replace CVD or whether individuals in favorable CV health actually experience an extension of healthy life (i.e. without major morbidity). While we know that favorable CV health delays the onset of cardiovascular disease and increases longevity, its impact on cumulative lifetime morbidity remains unknown. The over-arching goal of this proposal it to understand how favorable cardiovascular health at younger and middle ages may achieve the goal of prolonging the period of healthy life and reducing the lifetime burden of morbidity (from all major chronic diseases) at older age. To accomplish this aim we will take advantage of the current linkage of the Chicago Heart Detection Project in Industry Study (CHA; 39,522 men and women screened in 1967-1973) with Medicare claims data through 2010, which will provide us with over 25 years of follow-up. We will then use sophisticated statistical methods to address the following specific aims. Specific Aims: 1. To determine whether favorable cardiovascular health at younger and middle ages is associated with the compression of CVD morbidity into a shorter period of time before death and/or lower average level of CVD morbidity in older age 2. To determine whether favorable cardiovascular health at younger and middle ages is associated with the compression of morbidity into a shorter period of time before death and/or lower average level of morbidity (from all major chronic diseases) in older age 3. To determine whether favorable cardiovascular health during middle-age is associated with lower cumulative, annual, and end of life Medicare expenditures.