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