Memphis Commercial Appeal

By Dr. Manoj Jain

Monday, October 13, 2008

Often at family gatherings or social events the conversation turns to the question: "how do you live longer?"

As a physician, I respond in no uncertain terms: "The elixir of long life is pretty simple stuff. Exercise, eat well, avoid stress, stop smoking and take preventive medications." But how exactly do these and other things affect our body's vital organs? If you are embarking on a health-improvement journey or are already on the road, here are tips and scientific findings to support the modifications in your behavior.

Medical science is incremental, so a single study is rarely the final word; the associations that come from observational studies are sometimes overturned by later trials. Read the numbers prudently and consult with your doctor about your journey to better health.

HEART HEALTH

High blood pressure

Problem: Blood pressure is measured by two numbers: the systolic reading (the top number), which shows the pressure when the heart is contracting, and the diastolic (the bottom number), which indicates the pressure when the heart is relaxing. Both are measured in millimeters of mercury (mmHg), or points.

Reducing blood pressure lowers the risk of heart disease and increases longevity: For every increase of 20 points in systolic and 10 points of diastolic blood pressure, the likelihood of death from cardiovascular disease doubles. So, a drop from 150/90 to 130/80 (not a huge change) makes you far less likely to die from heart disease. People at age 50 with normal blood pressure live five years longer on average than those with higher blood pressure.

Medication: In a 1992 study, 4,396 patients who received a beta blocker and a diuretic for high blood pressure had on average a 19 percent reduction in coronary events such as heart attacks and a 25 percent reduction in strokes.

Cholesterol

Problem: A waxy substance your body needs to function normally, cholesterol can build up in your arteries and increase the risk of coronary heart disease and stroke. Cholesterol is measured as milligrams (mg) of cholesterol per deciliter (dl) of blood. It contains "bad" cholesterol (low-density lipoproteins, or LDL), which increases your risk of coronary heart disease, and good cholesterol (high-density lipoproteins, or HDL), which reduces your risk of coronary heart disease.

Ideally, you want your LDL count to be less than 100 mg/dl and HDL to be more than 40 mg/dl.

People who have cholesterol levels in the normal range live longer than those with elevated cholesterol. Physicians refer to the rule of 1 percent: For every 1 percent increase in the HDL and/or 1 percent decline in LDL, there is 1 percent lower risk of developing coronary artery disease.

Medication: A Scandinavian study of 4,444 patients with heart disease found that those given a cholesterol-lowering statin drug had a death rate of 8 percent over five years, compared with 12 percent for those on a placebo. Also, the rate of major coronary events (such as heart attack) was 19 percent for the statin group, but 28 percent for the placebo group.

One study of 22,071 physicians without a history of heart disease placed some on a low dose of aspirin (325 mg every other day). Over five years, the group taking aspirin had a 44 percent lower incidence of heart attack. People older than 50 saw the most benefit.

EXERCISE

High blood pressure: If you are overweight, lose 22 pounds and your systolic blood pressure will decline by five to 20 points. Regular exercise, such as brisk walking for 30 minutes most days, can drop your systolic blood pressure by four to nine points.

Cholesterol levels: In a 2002 study of 111 sedentary, overweight men and women, those who exercised intensely (the equivalent of jogging 20 miles a week) saw their HDL increase from 44.3 to 48.6.

Alzheimer's: An observational study of 1,740 adults older than 65 showed that 13 people per thousand developed Alzheimer's dementia among those who exercised three times or more per week. For those who got the least exercise, the rate was 20 per thousand.

DIET

High blood pressure: The average American eats only 4.4 servings of fruit and vegetables a day. One study showed that people who reduced the fat in their diet to 26 percent and increased fruit, juices and vegetables to 9.6 servings a day cut their systolic blood pressure by 5.5 points and diastolic blood pressure by three points. The percentage of fat in the average American's diet: 37 percent.

Cholesterol levels: A 1997 study of 444 men found that those who replaced an average American diet with a reduced-fat diet (26 percent fat) experienced a 13.4 percent drop in LDL.

STRESS REDUCTION

High blood pressure: A 2008 review of nine studies found that Transcendental Meditation reduced systolic blood pressure by 4.7 points and diastolic blood pressure by 3.2 points.

BRAIN HEALTH

Alzheimer's disease

Problem: Most people fear the loss of their mental faculties even more than a decline in physical health.

Currently, one in every eight people age 65 and older has Alzheimer's. The rate rises to one in two for people older than 85, according to the Alzheimer's Association. Although no study has found a silver bullet that will prevent dementia, more and more researchers think you can take steps to protect your brain as you age.

Mental exercise: In an observational study, people ages 75 to 85 who engaged in cognitive exercises such as board games, reading, playing a musical instrument and doing crosswords were significantly less likely to develop dementia over a five-year period than those who did not.

Medication: Individuals with high cholesterol who took statins had a 71 percent lower rate of dementia compared with those not on statins. A study of nearly 7,000 adults older than 55 who were followed for seven years had an 80 percent lower risk of Alzheimer's dementia if they had received nonsteroidal anti-inflammatories such as ibuprofen for more than two years.

LUNG HEALTH

Smoking

Problem: Smoking causes direct injury to the lungs, yet nearly one in five U.S. adults smokes cigarettes.

According to the 1990 Surgeon General's Report, people who quit smoking between ages 35 and 39 added three to five years to their lives, while those who quit smoking between ages 65 and 69 added one year to their lives. Smoking cessation reduces risk of heart disease, peripheral vascular disease and dementia, but most significantly it reduces the risk of lung cancer.

Nonsmokers married to lifelong smokers had double the rate of lung cancer compared with other nonsmokers.

Among 100 lifelong smokers 14 will die of lung cancer compared with less than one per 100 nonsmokers.

GENERAL HEALTH

Ideal weight plus 20 to 30 pounds: considered overweight.

Ideal weight plus 30 pounds or more: considered obese. But a loss of 10 pounds can lead to significant health benefits.

Increased risk of death during midlife of overweight people compared with normal-weight people:

Overweight: 20 to 40 percent

Obese: 200 to 300 percent

According to the 2005 Dietary Guidelines, those who are overweight should try to eat 500 to 1,000 calories a day fewer than they burn, which will help them lose one to two pounds a week. </font>

Text by Manoj Jain. Jain is an infectious-disease physician and clinical assistant professor at the University of Tennessee Health Science Center. He also serves on the Healthy Memphis Common Table's Community Partner's Council

To find links to abstracts and papers describing these studies and statistics, go to mjain.net. This article was previously printed in the Washington Post.

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