Maintaining a healthy lifestyle from young adulthood into your 40s is strongly associated with low cardiovascular disease risk in middle age, according to a new Northwestern Medicine study.

"The problem is few adults can maintain ideal cardiovascular health factors as they age," said Kiang Liu, first author of the study. "Many middle-aged adults develop unhealthy diets, gain weight and aren't as physically active. Such lifestyles, of course, lead to high blood pressure and cholesterol, diabetes and elevated cardiovascular risk."

Liu is a professor and the associate chair for research in the department of preventive medicine at Northwestern University Feinberg School of Medicine.

"In this study, even people with a family history of heart problems were able to have a low cardiovascular disease risk profile if they started living a healthy lifestyle when they were young," Liu said. "This supports the notion that lifestyle may play a more prominent role than genetics."

Published Feb. 28 in the journal Circulation, this is the first study to show the association of a healthy lifestyle maintained throughout young adulthood and middle age with low cardiovascular disease risk in middle age.

The majority of people who maintained five healthy lifestyle factors from young adulthood (including a lean body mass index (BMI), no excess alcohol intake, no smoking, a healthy diet and regular physical activity) were able to remain in this low-risk category in their middle-aged years.

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In the first year of the study, when the participants' average age was 24 years old, nearly 44 percent had a low cardiovascular disease risk profile. Twenty years later, overall, only 24.5 percent fell into the category of a low cardiovascular disease risk profile.

Sixty percent of those who maintained all five healthy lifestyles reached middle age with the low cardiovascular risk profile, compared with fewer than 5 percent who followed none of the healthy lifestyles.

Researchers used data collected over 20 years from the Coronary Artery Risk Development in (Young) Adults (CARDIA) study. It began in 1985 and 1986 with several thousand 18 to 30 year-olds and has since followed the same group of participants.

For this study, the researchers analyzed data such as blood pressure, cholesterol, blood sugar, BMI, alcohol intake, tobacco use, diet and exercise from more than 3,000 of the CARDIA participants to define a low cardiovascular disease risk profile and healthy lifestyle factors.

If the next generation of young people adopt and maintain healthy lifestyles, they will gain more than heart health, Liu stressed.

"Many studies suggest that people who have low cardiovascular risk in middle age will have a better quality of life, will live longer and will have lower Medicare costs in their older age," he said. "There are a lot of benefits to maintaining a low-risk profile."

The National Heart, Lung and Blood Institute and the National Institutes of Health funded this research.