To the Editor: Doctor comments on factors affecting length of life
Written by William E. Feeman Jr., M.D.   
Thursday, 14 November 2013 10:09
The key to a long life with the fewest medical "glitches" is the ability to avoid the problems that come with atherothrombotic disease (ATD, such as heart attacks and strokes) and cancer.  No one lives forever, but if one likens the game of life to a game of cards, then the winners are those who can play their cards a bit longer before they have to cash in. In light of this I would like to note that Nancy Orel, PhD, in her talk in the Optimal aging seminar is "spot on" when she advises people not to smoke if they want to live a long time. And I could not agree more that a "happy wife is a happy life."
Cigarette smoking underlies early-onset ATD and cancer. People who smoke and have ATD risk factors have their ATD events much earlier than do ex-smokers and never smokers.  They also get many more cancers than do never smokers; ex-smokers may/may not get cancer - but if they do, the cancers come at a much later age. The only cancer I know of that is not associated with cigarette smoking is breast cancer, but if a woman smokes, her most likely cancer is lung cancer, with breast cancer a close second.
I was disappointed to note that Dr. Orel placed emphasis on flossing one's teeth in association with a longer life. Gingivitis is associated with increased inflammation, and there are some researchers who believe that the underlying basis of ATD is inflammation. This dates back to the work of Paul Ridker, MD, who found evidence that ATD is an inflammatory process. This is true, but that inflammatory state was set up by an inflammatory response to the known ATD risk factors: cholesterol disorders, cigarette smoking, high blood pressure, diabetes, etc. As Ridker himself pointed out over a decade ago, the highest inflammatory states in the world exist in Africa, where malaria is rife and ATD is not. No one has ever shown that gingivitis, which is more common in people who do not floss, in and of itself causes ATD. Flossing will keep your teeth healthier, but no one has shown that it will prolong your life.
I was even more disappointed to see that Dr Orel did not mention cholesterol disorders (dyslipidemia), hypertension, and even diabetes as critical conditions that require correction if one is to avoid ATD.  People who live a very long time tend to have wonderful cholesterol levels (either naturally or as a result of treatment) and little in the way of hypertension (either or as the result of treatment). Diabetes is something that often comes with age, so as long as the blood sugar level is reasonably well controlled, diabetes should not, in such cases, interfere with a long life. (When I last checked, some 10 years ago, my diabetic patients who had never smoked cigarettes, died at an average age of 80 years - which was way beyond the normal lifespan at the time.)
William E. Feeman Jr., M.D.
Bowling Green

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