Today, we're tackling a heavy question, one that we see in clinic all the time. It's the question of what's the point of no return, right? Whether you have a patient or maybe you are the patient, you're staring down a chart full of diagnoses like diabetes, heart disease, or maybe history of a stroke. You can wonder, does anything I do really matter anymore? Is the damage already done, or is there still time to turn the ship around? And today, I'm going to talk through a 2026 study from Wang et al. in the American Journal of Preventive Cardiology that gives us a definitive answer. And spoiler. It's probably never too late. So, let's dive into it right away. So, first things first, let's start with his mindset. We have to kind of avoid and fight this fatalistic viewpoint, right? So, when we're talking about cardiometabolic multimorbidity, which is what they're talking about here. This study is defined as having two or more serious conditions like type 2 diabetes and heart disease or stroke. So, those are that's what we're talking about when we talk about cardiometabolic multimorbidity. And the natural human reaction is to think, well, that ship sailed, right? Like, why bother with the gym? Why bother eating a salad? It's too little, too late. But here's the reality check: this new data proves that the mindset of Fatality is probably wrong. We are going to look at what the evidence shows, and optimizing our lifestyle, even if you have something going on, can add years to your life expectancy. So let's look at the study design first, and it's pretty robust when it comes to participants. The researchers use the UK Biobank, and they followed about 260,000 participants for a median of 14 years, and so they essentially watched an entire generation. And to answer the question that they're looking for here, meaning is it too late ever, they split this group into three buckets based on how sick they were at the starting line. So, group number one were the cardiometabolic disease-free healthy controls. So, they had nothing going on. That's what we started with. Then we had a single multimorbid condition, so folks with a single condition, and then we had the multi-morbidity group, so the highest risk group. These folks. Had two or three concurrent conditions, specifically type 2 diabetes, ischemic heart disease, or a stroke. But before we move on, we need to answer the question: how do they actually measure health, right? Health can be sometimes subjective, right? In terms of are you healthy according to this or something like that? And so they use something objective, which can be made helpful. They use the American Heart Association's Life Essential 8, and they gave everyone a score from 0 to 100. Essentially, they categorize them then into three groups. So, the red zone, which is the low health, this is our reference group, it's less than 50. The yellow zone is between 50 and 79, this is quote unquote moderate health, and then the high health group. Is over 80, and that's our green zone. So, once again, three main groups. And here's a scorecard for the things they actually looked at, right? So, life's essential eight, it's very well known, but there are four things you do, and four things you measure. So, specifically, there are behaviors and biometrics. So, behaviors are diet, activity, sleep, and nicotine consumption, and the biometrics are BMI. Cholesterol, glucose, and blood pressure. And so you might be saying, All right, cool, that's great. That still sounds very nebulous. How do we measure it? Well, I'm glad you asked. That's what we're going to talk about here. And the AHA has kind of made this standardized. So we have this life's essential eight, and they kind of understand that, hey, a perfect score, quote unquote, is 100, and an average score is 50. And so that's what we're looking for. So Looking at this again here, diet. So, here they assess the nutritional quality. So, this is definitely the hardest, and this is definitely the most controversial, right? So, if you go online, people are going to say, oh, this isn't a healthy diet, but it is what it is. That's what they use. But this can be controversial, but they measured essentially your adherence to this, and they give you a score. Getting a score of 100 requires pretty much super high consistency. But what they do measure is your adherence to either a Daesh diet or Mediterranean-style diet. And so, for an example, a perfect 100 would have a high intake of fruits, vegetables, whole grains, beans, legumes, nuts, fish, and olive oil. And here, they want you to limit, have a minimal intake of red and processed meats, sugar-sweetened beverages, and sodium. And this represents really like the top 5% of people in the population, right? Like to get 100. And so that's kind of where they're at. Whereas the middle is like 50%. This is like an average diet. So you eat some veggies, maybe. Some whole grains, but we also consume lots of processed foods, sugar drinks, or red meat regularly, two to three times a week. Once again, I'm not saying this is perfect, but this is what they use. And I know a lot of people have a lot of opinions on this, but And to have a low one, you have a typical Western diet, right? So, high in ultra-processed foods, added sugars, saturated fats with minimal produce intake, just eating processed food, essentially what it is. So, that is for diet. For physical activity, this is assessing movement. They're measuring weekly minutes of moderate to vigorous physical activity. In the perfect 100, you have 150 plus minutes of moderate activity or 75 of vigorous For example, running five days a week for 30 minutes would cover that. They didn't talk about resistance training specifically, but I always have to recommend you have to do that. That's the formal recommendations of the guidelines, but that's what they base it on. Middle 50 would be if you're between one and 149 minutes. So, quite the range there. So, in the middle category, you could just exercise two minutes a week in your middle, whereas the low is a zero. So, you don't work out at all. So, you know, we have quite a range there, but that's what we looked at. From a nicotine exposure, essentially they're asking: Do you use e-cigarettes like vaping? Do you have exposure to smoke? Do you smoke cigarettes or do you have secondhand smoke exposure? And Perfect100 is never smoker or quit more than five years ago. The middle 50 would be someone who quit smoking less than five years ago. Also, you do lose points, like 20 points, if you live with a smoker and have secondhand smoke exposure. And then low is current smoker or vapor. And I think it's interesting they include vape as well. Probably safe to do that, right? We don't know necessarily is it as bad as cigarettes, but probably not helpful inhaling chemicals into our lungs. That's just what we're thinking about. And then sleep is another one here. So this is kind of a newer addition to the Essential eight for the seven, they didn't have this, but in the new Essential Eight, they have that. This is average hours of sleep per night. So the perfect 100 is seven to nine hours. Middle 50 is six to seven, or nine to ten. They say that sometimes that's too much. So if you're sleeping too much, but usually six to seven. And then the low score would be less than four hours per night, which is pretty hard to do, but some people do it. And then moving on to the biometrics, we have BMI, so a calculation of weight relative to height. I've talked about BMI a lot previously and how it's not the perfect thing, but it's very good for large data sets. So we have this data and we'll use it. So the perfect 100 is a BMI less than 25, middle 50 is 25 to 29. 9, and then low is BMI greater than 40, they said specifically. So that's kind of where that ranges. And then lipids, cholesterol, they looked at non-HDL specifically. And why one non-HDL they mentioned specifically, it measures all the atherogenic particles, right? LDL and VLDL doesn't require fasting. And they say this probably is the best indicator that we have. And so to get perfect. It's less than 130 for the non-HDL. Middle is less is 160 to 189. And then low would be greater than 220. So meaning zero, like zero is greater than 220. So there's that range there, right? You're sitting. Between 190 to 220, you get a certain amount of points, but that's essentially what the cutoffs are. Blood glucose, they looked at fasting sugar or A1C for a three-month average. As we know, perfect 100 is fasting glucose less than 100 or A1C less than 5. 7. And this is a normal range without medication to clarify that. Middle of 50 is kind of pre-diabetes range in that you know A1C of 5. 7 to 6. 4 and glucose of 100 to 125. And then zero would be diabetes with A1C greater than 10. So obviously, you can still have diabetes, less than 10, still get points, but no points or 10. Then blood pressure. And specifically, perfect was less than 120 over 80, middle is 120 over to 129 over systolic, diastolic 130, 139, and then low is greater than 160 over 100. And so This list might sound overwhelming. You might be like, Jordan, why did you include that? Well, it's important to know what we're looking for, right? If you're anything, you can use these to have just general goals. Like, oh. I never thought about my target blood pressure. I never thought about what we're looking at from a dietary perspective, what we're looking at from a sleep perspective. So, just can be used as general ones, and then you're refining what works best for you and your patients, right? That's how it goes, but that's where it is. I'm trying to find like the vital few, the most important things, not just like everything on earth. And so, like, this is a great place to start. It can be helpful. Sorry, there's a little bit long, but I think it's helpful to know what they're looking for. And so let's look into the results here. So, what did the data find? The data found a linear dose response when it comes to changing the life essential eight. And outcomes. So, for every 10 points you increase your score, your risk of death dropped roughly 20%. And here's the kicker: this held true for everyone. So, whether you were a healthy person with no issues or someone with three chronic conditions, the relative benefit of getting a little bit better was exactly the same. You don't need to jump from zero to 100, just get 10 points. If you get 10 points, you see that decrease in 20%, is what they saw across all three groups. Specifically, now let's talk about life expectancy with some hard numbers. So the researchers calculated residual life expectancy starting at age forty five. They asked a specific question If we take a patient with a low score and compare them to a patient with the exact same disease burden who maintains a high score, like a high health score, how many extra years of life does this actually buy? And let's walk through each group. So, first, we have the healthy baseline. These are people with no cardiomybologic disease. And if they maintain high cardiovascular health, they gain 11 years of life compared to healthy people with poor habits. So, essentially, at the start, they had no disease, but one group. Had good habits, one had bad habits, the good habit group 11 extra years. That's pretty darn impressive. Second, let's go to the single diagnosis group, right? So, the people managing one major condition, and the data shows. That by optimizing their lifestyle, they can still gain 8. 7 years, and reclaiming nearly a decade by improving their health, even if they have an underlying diagnosis. And then finally, we have the multimorbidity group, right? So, the patients with two or three major conditions, and this group is usually the one where people are like, ah, the damage is done. Well, the data kind of proves otherwise. Even with the heaviest disease burden and rigorous maintenance of a healthy lifestyle, it adds 8. 1 years back to their life. So, clinical takeaway here. If you see the difference between the single diagnosis group, which is 8. 7, and the multi-morbidity group, which is 8. 1, the gap is only about 0. 6 years. And it tells us something profound, right? So, disease is not too far gone where you can't repair it anymore, right? It's still there. The benefit of lifestyle invention remains potent even in the presence of complex chronic illness. Another thing that I think is worth mentioning, which is kind of cool, I don't have a great explanation for it, was there's kind of some nuances here. So Among all the eight factors, they found that nicotine was by far the strongest factor. So, if you smoke, this is your first thing to start. I always tell people all the time: if we can quit that, that's wonderful. That's the biggest improvement. Obviously, we know it's not that easy. It's very, very challenging, very addictive, but they found that that was the most important. And on top of that, they found some super responders. So, specifically, women with multimorbidity saw a 92% reduction in mortality risk with high scores. So, going at getting to that high range. For whatever reason, they didn't have the reason. I don't have the reason, but it's seen that in the study, women seem to have incredible responses to this. So, Yeah, men, it's not for nothing, right? There's still 48% drops, so still very important, but for whatever reason in this study, women had a quite a robust response. Going into why does this work? So, the authors discuss epigenetics, right? Or essentially altering the things above your genome, not actually altering your genes, but how your genes are expressed. I kind of think about the genes as the hardware, right? And lifestyle as the software. High health scores slow down the resting of the hardware. That's a gross exaggeration, but. Overall, we are just kind of slowing down what we're doing and we are just helping express our genes in a better way. That's what I think about. And so there are limitations, though, to this. First thing first is like, we don't know necessarily what's going on, but I do want to talk about the limitations for that. And first of all, this was an observational study, right? We rely on people telling the truth about their diets and We know that dietary intakes are not pretty good. They're not very good. And so that's what it is. But overall, when we have data like this, it's more of a, hey, what does this look like? Why is it showing the signal? Does it actually show something? Let's go. And so, after seeing all this, you're like, okay, that's great. That seems overwhelming. How do we actually implement this? Well, I'm glad you asked. For me, I want to kind of just introduce the idea of like, how do we get into this, right? So, a lot of times I talk with people who are minimizers. Or optimizers, and we'll talk about both. So, for the minimalists, if you're overwhelmed, don't go for a perfect score, right? We want to get ourselves or our patients up just a little bit. Improving just a little bit can be really helpful. Smoking, specifically, if we can do that. That would be wonderful, or fixes sleep, big thing. So if you say one thing to pick, that's it. But for the optimizers, if you want to go full, again, a full decade of life. Aim for the green zone, right? So, getting above 80. And so, for this, you really got to lock in all those things. You need sleep to fuel your exercise and recovery. You need to have a health-promoting diet, all those things. Really, if you want to optimize everything, you're going to have to touch each of those specific things. But if you just want to be a minimalist and say, hey, I need to make some small improvement. It's picking SMART goals, right? It's picking one thing that you and a patient can agree on, and then moving from there. So you're still getting improvement. And so there's a huge spectrum. So you can have people who Really haven't done much to further health, and you can help them. And also, people who are optimizing, you might say, Hey, you're doing good, keep going, or you can kind of work with them as well. And so, what's the big takeaway here? It's that Scientifically and statistically, it's not too late to try to get healthier. No, we looked at these people who had these multimorbid conditions and they did see improvement. That's my big takeaway from this. Is this a randomized control trial proving that one specific thing is the most important? No, it's not. But As an observational study, it's nice to see that hey, we saw this trend, and overall, it kind of is congruent with what we think, right? We think that making lifestyle changes can have an impact. What I like seeing is making lifestyle changes having a big impact. To me, a lot of times people are like, oh, what difference does it make if I do this? Well, it can be a big deal. And even these big numbers of dropping 20-some percent with just increased 10 points, that's a big deal. And so this gave me a lot of. Hope and encouragement that for patients, we can say, Hey, we can get you better, even if it's just a little bit, even if we just do a little bit, we can get you significantly better and give you a better quality of life. That's really what we're looking for. And that is going to be it for today. Thank you so much for tuning in. If you did find this helpful, it means the world to me if you share this with a friend. That's the one thing I ask. Just share with someone you think may enjoy this. Uh, but other than that, that's going to be it. Now, get off your phone, get outside, have a good rest of your day, and we'll see you next time. This podcast is for entertainment, education, and informational purposes only. The topics discussed should not solely be used to diagnose, treat, or prevent any condition. The information presented here was created with an evidence-based approach, but please keep in mind that science is always changing, and at the time of listening to this, there may be some new data that makes this information incomplete or inaccurate. Always seek the advice of your personal physician or qualified healthcare provider for questions regarding any medical condition.
