You have probably heard the saying that healthy living adds years to your life. But many of my patients ask a deeper question, and it is a fair one: what good are extra years if they are spent frail, in pain, or unhappy? Nobody wants to simply last longer. We want to live well for as long as we are given.
A remarkable new study published in the European Journal of Preventive Cardiology takes on exactly this question, and it does so with something almost no other study can offer: a follow-up that spans nearly the entire adult lifetime of its participants. The answer it gives is encouraging, and I think it should shape how you think about your health in your 40s, 50s, and beyond.
A study that followed men from midlife to the end of life
The Helsinki Businessmen Study began in the 1960s. Between 1964 and 1973, a group of healthy Finnish men born between 1919 and 1934 came in for voluntary health checkups. At the time, their average age was about 42. They were business executives and professionals, so they shared similar education, income, and access to health care. That matters because it removes much of the “noise” that usually clouds studies like this one, where wealthier people tend to live longer for reasons unrelated to blood pressure or waistline.
Researchers measured five simple things in 2,690 of these men and then followed them for decades. By January 2025, about 94% of the men had passed away, and every one of them had lived long enough to reach age 90. In other words, the researchers could finally see the full story of how these lives unfolded.
The five “low-risk” markers
At the first visit, researchers checked each man for five markers of low cardiovascular risk. He was a non-smoker. His body mass index (BMI) was under 25. His systolic blood pressure (the top number) was under 140 mmHg. His total cholesterol was under 6.0 mmol/L (roughly 232 mg/dL). And his blood sugar one hour after drinking a glucose solution was under 9.0 mmol/L (roughly 162 mg/dL).
That last measure deserves a closer look. A one-hour post-load glucose reading comes from a glucose tolerance test, and it shows how well your body handles a sugar challenge, not just where your blood sugar sits after an overnight fast. It is a window into metabolic health that routine checkups often skip.
Researchers then grouped the men by how many of these five markers they had. Only 59 men had none. At the other end, 105 men had all five.
The first finding: more years
The longevity results were striking and followed a clear staircase pattern. Among men with none of the five low-risk markers, only 6.8% lived to see their 90th birthday. With one marker, that rose to 14.2%. With two, 18.3%. With three, 26.7%. With four, 36.6%. And among men who had all five in midlife, 41.9% reached age 90.
Put another way, the healthiest men in their early 40s were about six times more likely to reach 90 than those with the poorest profile. After adjusting for age, men with none of the markers had about two and a half times the risk of dying during follow-up compared to men with all five. The age-adjusted survival time from that first checkup ranged from 31.8 years in the highest-risk group to 42.7 years in the lowest-risk group, a difference of roughly a decade of life. The chances of reaching 95 and even 100 also climbed steadily with each additional healthy marker.
The second finding: better years
Here is where this study becomes truly valuable. In 2007, when the surviving men averaged 79 years of age, 907 of them completed a detailed survey about their health, function, and state of mind. Importantly, the response rate was similar across all the risk groups, so the healthiest men were not simply the ones more likely to fill out the paperwork.
The differences were substantial. Among men who had zero or one low-risk marker in midlife, 24.5% were frail at age 79. Among men who had all five, only 2.2% were frail. That is a remarkable gap. Men with the healthiest midlife profile were about 2.3 times more likely to be robust and free of frailty in their late 70s. And when the researchers looked at the whole original group, including those who had already died, men with all five markers were nearly five times more likely to be both alive and not frail at 79.
The healthiest group also carried a lighter disease burden. Only 42% of them had two or more chronic conditions, compared with 66% of the highest-risk group. Diabetes affected about 2% of the low-risk men versus about 21% of the high-risk men. Problems with basic daily activities were roughly half as common. Interestingly, low-risk men were also far less likely to be taking a statin in old age (about 42% versus 76%), suggesting their good numbers tended to stay good.
On a standard quality-of-life questionnaire covering eight areas of life, men with all five markers scored highest in every single one. The differences were clearest in physical function, energy and vitality, pain, social life, and overall sense of health.
The third finding: happier years
The researchers also asked the men to rate their happiness on a scale from 0 to 10, similar to the method used in the World Happiness Report. Men with all five low-risk markers in midlife averaged nearly 8.0, compared with about 7.4 for those with zero or one. That difference just missed the usual cutoff for statistical significance, so I would treat it as a strong hint rather than a proven fact. Still, the healthiest group’s score was higher than Finland’s national average, and Finland has been ranked the happiest country in the world.
Psychological wellbeing told a similar story. Men were asked whether they felt satisfied with life, had zest for living, felt needed, had plans for the future, and whether they struggled with loneliness or depression. Those who answered positively across the board made up 55% of the low-risk group but only 39% of the high-risk group.
What about weight gain in young adulthood?
One more detail caught my eye. The men were asked what they had weighed at age 25. Those with all five low-risk markers in midlife had gained, on average, only about 3.5 kilograms (roughly 8 pounds) between age 25 and their early 40s. Those with none of the markers had gained nearly 18 kilograms (roughly 39 pounds). The authors point to weight gain before midlife as one of the key challenges of our time, and I agree. The habits of your 20s and 30s quietly set the stage for the decades that follow.
An honest look at the limitations
Every study has limits, and I want you to understand them. These were white, well-educated, relatively prosperous Finnish men, so we cannot be certain the results apply equally to women or to other populations. This was an observational study, which means it shows strong associations but cannot prove cause and effect. Genetics surely played some role, although the researchers noted that height and a known genetic risk marker for heart disease and dementia (ApoE4) were similar across the groups. Frailty and quality of life were measured using the same questionnaire, so they overlap somewhat.
On the other hand, the authors believe their findings may understate the benefit. The cutoffs they used for cholesterol and blood pressure are more lenient than what we consider healthy today. And these men built their low-risk profiles without modern medications. Their good numbers came from how they lived, and perhaps from how they were made.
What this means for you
For decades, a question has lingered in medicine: does a healthier life simply stretch out the years of decline, or does it compress illness into a shorter period near the very end? This study offers some of the strongest lifelong evidence we have that the second outcome is achievable. The men who entered midlife with healthy numbers didn’t just live longer. They lived longer while staying stronger, more active, less burdened by disease, and more content.
I find that deeply hopeful. Your body was designed with an extraordinary capacity for resilience, and caring for it is stewardship that pays dividends throughout life. The five markers in this study are not exotic or expensive. Do not smoke. Keep your weight in a healthy range and guard against gradual gain in young adulthood. Know your blood pressure. Know your cholesterol. And ask how your body handles sugar, not just what your fasting glucose shows.
If you are already past 40, please do not read this as a verdict. The lesson is that these markers matter, and every one you move in the right direction improves your odds. Whether you are 35 or 65, today is a good day to learn your numbers and begin investing in the kind of old age you hope to enjoy.
