My research career began focusing on the benefits of cardiac rehabilitation programs. As I spent more time with the patients and learned more about heart disease, I realized two things. First, many cardiac rehab patients enthusiastically indicate at the end of the program they’re in the best shape of their lives. The second, heart disease (and many other diseases) starts decades before the first symptom. Yet many in society think it starts when they get chest pain or have a heart attack.
But what if, instead of waiting for that heart attack to happen, people could be in the best shape of their lives decades before and maintain that? What effect would lifelong prevention such as exercise, healthy nutrition, quality sleep and mental well-being have? Surely some (or many) of the patients I saw could have prevented having that heart attack.
Chronic Diseases Start in Your 20s or Earlier
Most chronic diseases are diagnosed at the appearance of signs and symptoms. For example, chest pain for heart disease, slurred speech for stroke and the presence of a lump for cancer. It is usually these symptoms, which prompt people to see their doctor or go to the ER. This makes sense, if we felt fine, why would we seek care. Often further tests are done and treatment provided. However, for some people, the first symptom can be so severe it can lead to lifelong disability, as in stroke, or even death, as in sudden cardiac death.
For some diseases, such as diabetes, your doctor may check your blood sugar levels. Even if you don’t have symptoms. If your blood sugar is at a certain level, you may be diagnosed with diabetes. This provides an opportunity to get treated before symptoms can occur. And in most cases, it either delays, or prevents altogether, any future problems related to the disease. But even then, treatment mainly keeps it at bay. Rarely are chronic diseases reversed or cured.
In 1971 a landmark study came out on those who died in the Vietnam war. It revealed the presence of atherosclerosis in men as young as 19 years. This finding upended the belief heart disease was a disease of the old. The same is true of diabetes. By the time blood sugar levels rise, there are already problems with insulin metabolism. And osteoporosis is termed the childhood disease with old age consequences because bone mass is established in the teenage years, yet the disease shows up decades later.
Is better screening the solution?
One solution often considered is creating better and more advanced screening programs. Health screening is put in place to identify people who may have a greater likelihood for a disease before any symptoms occur. Examples include measuring blood sugar to screen for diabetes, conducting mammograms for breast cancer, or exercise stress tests for heart problems. Screening before symptoms occur allows for early treatment, which can prevent the disease from progressing and causing more serious complications.
Some may ask why not screen everyone. Then we’d have a better chance at preventing complications in more people. The problem is screening isn’t perfect. And when it isn’t, it can have negative impact on the person. Not every woman who has a positive mammogram will have cancer. Not everyone who has a positive stress test will have atherosclerosis. These are referred to as false positive tests—a positive screening test followed by a more precise negative test.
Yet those who test positive will undergo additional testing. Some of the testing may be invasive, such as an angiogram, which has a very small (<1%-2%) but real risk associated with it. And false positive tests are also associated with psychological distress and anxiety. For these reasons, guidelines for screening are designed to select those people who may most likely have a disease. This could be based on age, family history, risk factors and any potential symptoms.
The Value of Lifelong Prevention
Screening is a vital and important part of health care and disease treatment. But it does not prevent disease from occurring. Rather, screening works by detecting a present disease, albeit at an early stage. In which case, early treatment may reduce the chances of future harm from the disease.
However, screening cannot make up for a lack of prevention. Despite many chronic diseases thought to be a problem of aging, most have their foundations in our teens, 20s and 30s. We know long-term exercisers enjoy a healthier life, less disease and an increased lifespan. The same is true of maintaining healthy nutrition, quality sleep and focusing on mental well-being.
This does not mean one can be too old to start on prevention through a healthy lifestyle. Or there is no benefit once a disease has been diagnosed. Far from it. Cardiac rehabilitation exists because it works. Adopting a healthy lifestyle even after having a heart attack results in less chances of another heart attack and early death. Similarly, lifestyle interventions have the potential to reverse diabetes.
We don’t know who’s going to get a chronic disease later in life by looking at them in their 20s or 30s. But we do know lifelong prevention through healthy living will reduce your chances for getting a chronic disease and minimize any complications.
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