National Academy of Medicine, 18 November 2024

Population Health: The Power of Prevention

Modifiable lifestyle factors are profoundly powerful in maximizing health span and lifespan. Numerous long-term epidemiologic studies provide compelling evidence that self-care behaviors, such as being physically active, eating a nutritious diet, maintaining a healthy weight, not smoking, avoiding excessive alcohol intake, and getting sufficient sleep, are critically important for maintaining cardiometabolic health (e.g., favorable lipid, glucose, and blood pressure levels). Moreover, these factors have been linked to a lower risk of developing coronary heart disease (CHD), stroke, heart failure, cancer, type 2 diabetes, dementia, and other chronic conditions (Table 1), as well as to slowing of biologic aging (as reflected in biomarkers such as DNA methylation, the epigenetic clock, and telomere length).

Much of the literature on this topic over the last quarter-century is relevant to women’s health. In the Women’s Health Initiative (WHI), a diverse cohort of more than 160,000 US postmenopausal women aged 50–79 followed for 10–17 years, women with a healthy lifestyle were about one-seventh as likely to develop cardiovascular disease (CVD) and one-fourth to one-third as likely to develop heart failure than their counterparts with an unhealthy lifestyle (Foraker et al., 2016). Also, women with both a healthy weight and higher physical activity level had less than one-third the risk of type 2 diabetes than those with obesity and lower physical activity (Ma et al., 2012). Similarly, data from the Nurses’ Health Study, which followed 85,000 US female nurses aged 35–59 for decades, suggest that 82 percent of CHD cases, 74 percent of total CVD cases, 91 percent of type 2 diabetes cases, and 41 percent of cancer cases in women could be prevented by engaging in regular physical activity, eating nutritious food, maintaining a healthy weight, not smoking, and limiting alcohol consumption (Stampfer et al., 2000). Data from younger female cohorts show that healthy lifestyle behaviors are associated with lower risks of preeclampsia and other adverse pregnancy-related events and also modulate the association between such events and later-life cardiometabolic risks.