Favorable Cardiovascular Health and the Compression of Morbidity in Older Age

描述（由申请人提供）：具有良好心血管（CV）健康状况（即所有主要心血管危险因素，包括血压，胆固醇，体重指数，不吸烟，无糖尿病诊断）的人，在中年期间已被证明具有较低的心血管疾病风险和较长的寿命。先前关于具有良好CV特征的益处的研究分别检查了发病率和死亡率等结果。到目前为止，尚不清楚其他疾病是否简单地取代了CVD，或者是否良好的心血管健康个体实际上经历了健康生活的延长（即没有重大发病率）。虽然我们知道良好的心血管健康可以延缓心血管疾病的发病并延长寿命，但其对累积终生发病率的影响尚不清楚。该提案的首要目标是了解青年和中年有利的心血管健康如何实现延长健康生活期和减少老年发病率（来自所有主要慢性疾病）的终生负担的目标。为了实现这一目标，我们将利用目前芝加哥心脏检测项目工业研究（CHA； 1967-1973年筛查39,522名男性和女性）与2010年医疗保险索赔数据的联系，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；确定中青年良好的心血管健康状况是否与CVD发病率压缩到较短的死亡前时间和/或较低的老年CVD发病率平均水平有关2。确定年轻和中年时良好的心血管健康状况是否与死亡前较短时间内的发病率和/或老年时较低的平均发病率（来自所有主要慢性疾病）有关。确定中年时期良好的心血管健康状况是否与较低的累积、年度和临终医疗保险支出相关。

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.