Recent Advances:
1. Nissen, et.al., Effect of Very High-Intensity Statin Therapy on Regression of Coronary Atherosclerosis. (Journal of the American Medical Association 295, March 16, 2006). Treatment with 40 mg/day rosuvastatin achieved an average LDL-C of 60.8 mg/dl and raised HDL-C by 14.7%. This can reverse atherosclerosis in coronary disease patients.
2. Mehta and coworkers, Comparison of Mortality Rates in Statin Users Versus Nonstatin Users in a United States Veteran Population. (American Journal of Cardiology, 98, October 1, 2006). A study of 1.5 million veterans (with 1/2 being age 70 or above) found that a statin reduced the all-cause death rate, and added two years to life.
3. Fox, M. and coworkers, Decline in Rates of Death and Heart Failure in Acute Coronary Syndromes 1999-2006. (Journal of the American Medical Association, 297, May 2, 2007). During the period, 1999-2006, improvements in management of patients with ACS reduced rates of heart failure by 9% and and hospital deaths by 18%.
Cancer: Cancer is the second-highest barrier to longer life. While deathe from cardiovascular dropped sharply from 1970 to 2002, deaths from cancer decreased only 3%. For men, cancer's leading killers are (1) lung, (2) colon, (3) prostate, (4) pancreas, and (5) leukemia. For women, it's (1) lung, (2) breast, (3) colon, (4) pancreas, and (5) ovary. We can prevent 95% of lung cancer by not smoking. Daily aspirin prevents 40% of colon cancer. Annual medical exams are vital because early detection permits treatment by surgery, radiation, and chemotherapy.
Together, not smoking, daily aspirin, and regular medical exams can prevent 65% of cancers. This can extend life expectancy 6 years beyond that from preventing cardiovascular disease. A 35 year-old who follows measures to prevent cardiovascular disease and cancer can expect to live to 93 and a 65 year-old to 97.
Recent Advances:
1. Poynter, et al., Statins and the Risk of Colorectal Cancer. (New England Journal of Medicine, 352, May 26, 2005) Use of statins was associated with a 47% relative reduction in the risk of colorectal cancer after adjustment for other known risk factors.
2. Flossman, E. and Rothwell, P., Effect of Aspirin on Long-Term Risk of Colorectal Cancer: Consistent Evidence from Randomised and Observational Studies. (The Lancet, 369, May 12, 2007). Daily doses of 300 mg of aspirin reduced risk of colorectal cancer 26% in the short term and 37% after five years.
3. Lawson, K. and coworkers, Multivitamin Use and Risk of Prostate Cancer in the National Institutes of Health-AARP Diet and Health Study. (Journal of the National Cancer Institute, 99, May 16, 2007). More than one multivitamin per day increased advanced and fatal prostate cancer, especially if accompanied by selenium, beta-carotene, or zinc.
Stroke: The third highest barrier to longer life can be mostly prevented by not smoking, exercise, diet, avoiding obesity, annual medical exam, cholesterol-lowering drugs, aspirin, and hypertension control. The most significant advance in treatment is use of a clot-buster drug to treat the 2/3 of strokes caused by artery blockage.Together, these actions to prevent stroke can extend life expectancy 2 years beyond that from preventing cardiovascular disease and cancer. Together with prevention of cardiovascular disease and cancer, this raises the life expectancy of a 35 year-old to 95 and a 65 year-old to 99. Since 1970, deaths from stroke have decreased by 63%.
Recent Advances:
1. Chen, P. and coworkers, Inosine Induces Axonal Rewiring and Improves Behavioral Outcome after Stroke. (Proceedings of the National Academy of Sciences, June 23, 2002). Giving inosine to rats, after a stroke, induced brain rewiring and recovery.
Chronic Lung Disease: This fourth-highest barrier to longer life is easily prevented, since 85% of it is caused by smoking. The remaining 15% is from air pollution and other causes. Preventing chronic lung disease extends life expectancy a year beyond that from preventing other diseases. This raises life expectancy of a 35 year-old to 96 and a 65 year-old to 100. Unfortunately, foolish people continue to smoke and deaths from chronic lung disease have doubled since 1970..
Diabetes: The fifth-highest barrier to longer life comes in two forms. Type I diabetes can't be prevented or cured today. Victims require insulin and careful diet management. Type 2 diabetes, which is more than 90% of all diabetes, can often be prevented by diet, exercise, weight control, and drugs. Men with Type 2 diabetes cut in half their chance of death from diabetes if they exercise for 30 minutes per day. Obesity, a major cause of Type 2 diabetes, is pandemic in the United States. Two of every three adults are overweight or obese. As a result, diabetes has risen 45% since 1987. Prevention or successful treatment of diabetes extends life expectancy a year beyond that from preventing other diseases.
Recent Advances:
van Dam and coworkers, Coffee Consumption and Risk of Type 2 Diabetes. (Journal of the American Medical Association, 294, July 6, 2005). Habitual coffee consumption is associated with a much lower risk of type 2 diabetes.
Milne, et al., Small Molecule Activators of SIRT! as Therapeutics for Treatment of Type 2 Diabetes. (Nature, 450, November 29, 2007). In lower organisms and mice, Resveratrol, a component of red wine, lowers insulin resistance, increases mitochondria, and increases longevity. Now, some small-molecule inhibitors of SIRT! have been found to be 1000-times more effective. In rats, they improve glucose homeostasis, increase insulin sensitivity, and increase mitochondrial number. These substances may be highly effective therapeutics for diabetes.
Pneumonia: The sixth-ranking disease to stop longer life can usually be prevented by an immunizing injection. Sadly, most people don't get the injection. Even if pneumonia develops, physicians can sometimes treat it successfully with antiviral drugs, but many persons don't realize that they have pneumonia, and they die. Immunization extends life expectancy a year beyond that from preventing other diseases.
Alzheimer's Disease: Incidence of Alzheimer's rises after age 65. More than 30% of 90 year-olds have it. Today, there is no cure. In Alzheimer's disease, masses of two proteins, tau and beta-amyloid deposit in brain cells. Tau occurs in normal cells. The culprit appears to be beta-amyloid. It destroys brain cells, condenses to form clumps, and causes tau to glue together in tangled masses. Rise in beta-amyloid in brain correlates with loss of brain function.
Beta-amyloid is formed when two secretase enzymes snip it from a larger protein that is a normal part of cell membranes. They usually produce small amounts of beta-amyloid without causing problems, but when they produce large amounts, Alzheimer's disease results.
Prevention. Can you do anything to help prevent Alzheimer's? Ibuprophen appears to protect against its development (New England Journal of Medicine, November, 2001). Exercise correlates with lower Alzheimer's (Annals of Internal Medicine, January, 2006). Statins (Zocor or Lipitor, for example) lower the incidence of Alzheimer's (Archives of Neurology, 2000). Curcumin, found in curry, blocks beta-amyloid formation in mouse brain and removes beta-amyloid already present (Journal of Biological Chemistry, February, 2005). Resveratrol (a chemical from red wine) promotes degradation of amyloid-beta peptides that cause Alzheimer's. (Journal of Biological Chemistry, November, 2005)
Treatment. If you can't prevent Alzheimer's, several drugs slow its progress. Donepezil (Aricept) has the advantage of few side effects. Seligeline (Eldepryl) is also effective against Alzheimer's.
Recent Advances.
1. Mi, et al., Cystatin C Inhibits Amyloid-beta Deposition in Alzheimer's Disease Mouse Models. (Nature Genetics, 39, November 18, 2007) Cystatin C binds to soluble amyloid-beta and prevents its deposition as solid amyloid-beta in brain cells. The dependence on concentration of Cystatin C suggests that it may have therapeutic use in Alzheimer's.
2. Ray, et al., Classification and Prediction of Clinical Alzheimer's Diagnosis Based on Plasma Signaling Proteins. (Nature Medicine, October 14, 2007). Eighteen signaling proteins in blood plasma can be used to diagnose Alzheimer's disease with nearly 90% acuracy. Patients so diagnosed, even with only mild cognative impairment, developed full-blown Alzheimer's in two to six years.
Life Expectancy: Persons who use all preventive and therapeutic measures against disease can have a life expectancy of 98-102 years. Since not everyone does this, highest life expectancy today is 80 for men (in San Marino) and 86 for women (in Japan). According to the World Health Organization, the United States ranks 33rd in the world with life expectancies of 75 for men and 80 for women. Most nations ranking above the United States have government insurance coverage for all citizens, while the United States limps along with private insurance that millions of Americans cannot afford.
Updated 22 January 2007