8 Clues to Living Over 20 Healthy Years Extra

Chronic diseases like coronary heart disease (CHD), diabetes mellitus type 2 (DM2), cancers, and dementia are associated with over 80% of all healthcare costs and are the dominant cause of morbidity and mortality in the United States (US).

Lifestyle medicine has been proposed as a potential way to address the root causes of chronic disease and their associated health care costs.

A new study aimed to estimate mortality risk and longevity associated with individual therapeutic lifestyle factors and comprehensive lifestyle therapy in a large cohort of US veterans.

We can use the 8 Lifestyle Factors identified in this large study to make decisions about our own lives to live healthier and longer. 


A prospective cohort study of 719,147 participants aged 40-99 years enrolled in the Million Veteran Program (MVP) between 2011-2019 was accessed. The calculated age- and sex-specific mortality rates and hazard ratio (HR) for mortality.

Eight therapeutic lifestyle factors included never smoking, being physically active, not regularly binge drinking, "good" sleep hygiene, "good" diet, minimal stress, positive social relationships, and no opioid addiction.

Study outcome was all-cause mortality and estimated reductions in life expectancy.


Based on 1.13 million person-years of follow-up with 33,375 deaths, the researchers observed a mortality rate per 1000 person-years of 72.6, 46.3, 36.3, 29.8, 25.2, 20.8, 15.7, 12.3 and 7.4 among veterans who adopted 0, 1, 2, 3, 4, 5, 6, 7 and 8 lifestyle factors, respectively.

The risk of mortality was reduced by 5% for those with positive social relationships, 18% for those with good sleep hygiene, 19% for non-binge drinkers, 21% for those with good diet, 22% for those with minimal stress, 29%  for non-smokers, 38% for those with no opioid use disorder, and 46% for physically active veterans, compared with their counterparts.

Compared to those with no adopted lifestyle factors, veterans with a combination of 8 individual therapeutic lifestyle factors had a 13% reduction in all-cause mortality.

Men and women who adopted 8 therapeutic lifestyle factors could gain 24 or 23 years of life expectancy, respectively, at age 40 years compared to those with no adopted lifestyle factors.


 The 8 lifestyle factors studied were independently associated with a significantly lower risk of premature mortality, and the combination of these factors was associated with a multiplicative lower mortality risk.

This study gives some direction to adopting a multi-faceted lifestyle program for optimal longevity. The researchers commented that "We were really surprised by just how much could be gained with the adoption of one, two, three, or all eight lifestyle factors. Our research findings suggest that adopting a healthy lifestyle is important for both public health and personal wellness. The earlier the better, but even if you only make a small change in your 40s, 50s, or 60s, it still is beneficial."

Dr. Joel Kahn

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