Past Featured Article

IN SEARCH OF PROLONGED SURVIVAL

What’s Killing the Practice of Medicine.

Downlod PDF of Full Past Issues

Featured Article

IN SEARCH OF PROLONGED SURVIVAL

By: Hershel Hartor, MD

The premise for human survival is based upon two facets: life is fixed and
man is mortal. Excluding acute injury or trauma man will die from chronic
illness. As has been seen over the past 10 years, death from chronic disease can be postponed and the markings of aging can be modified.

Man has been known to exist for over 3 to 3.5 million years, initially as a hominid and ultimately as a family oriented human being. The human race started in Ethiopia. At that time we were all black and ultimately, as we migrated north, some of us lost our color and became the predecessors for the white race. To determine what would be an average age of the human race is difficult. If we review the book of Genesis and trace the family of Shem we find that Adam: was 130 years old when his son was born, that Noah was 600 years old at the time of the great flood and Abraham was 75 years old when he entered Canaan and fathered a son. He ultimately died at the age of 97. This is likely the age that the best of us can expect to reach if these biblical years are correct, assuming the years of survival as stated were correct.

Hypertension

Hypertension is one of the most common debilitating diseases in America. There are approximately 35,000,000 Americans with significant hypertension and only 30 to 40% are optimally treated. Upwards of 5% of these patients develop malignant hypertension. Seventy percent of the patients have mild hypertension (diastolic BP of 90-104 mmHg). Remember, the recommended blood pressure is 120 to 130/80-90 mmHg, except under certain circumstances. The incidence of hypertension increases with age such that by our 50th year approximately 50% of black Americans and 30% of white Americans are hypertensive with diastolic blood pressures greater than 90 mmHg which is a medically treatable condition. How should we treat this disease? A low salt, low fat, high potassium, carbohydrate restricted diet is the perfect place to start. Salt is everywhere. Most of it is not needed and for some reason a disproportionate amount of salt ends up in Louisiana. It is clear that as salt intake increases, blood pressure rises. It is also clear that a high potassium diet is consistently associated with a lower blood pressure. The mechanism whereby potassium rules blood pressure is via vascular resistance and the activation of Na:K ATPase. Obviously, pharmaceutical measures may also control blood pressure. We do not have the space here to discuss these drugs in detail, but the preferred antihypertensive agents used today are ace inhibitors, arb agents, vasodilators, and diuretics, especially the thiazide diuretics.

Exercise

Exercise is also a major contributing factor to prolonged survival. Thirty minutes; 3 times a week at 50 to 70% of VO2 max is all that is necessary. Several years ago, Harvard University reviewed the exercise activity of their professors. If they climbed five flights of stairs per day or more, they had a 25% reduction in heart attack rate. Those who did no exercise when adjusted for age had a 54% increased myocardial infarction risk. What activities are recommended? The exercise program must utilize a large muscle mass inducing an adequate increase in heart rate for an adequate duration of time. To calculate your exercise performance use the Karvonen formula where X% is the change in heart rate: X%= (HR max – HR rate) + HR at rest Exercise will have beneficial effect on cardiovascular function, carbohydrate metabolism, lipid metabolism, and have a great psychological affect. Exercise is also determined to reduce rates of several types of cancer, especially breast and prostate. It is important to remember that exercise need not be excessive.

Diet

HDL cholesterol (HDL2) is indirectly associated with cardiovascular events. Those individuals with the lowest HDL cholesterol and the highest risk of coronary disease are: 1 males, especially white 2 obese 3 those with a high carbohydrate diet 4 those with diabetes mellitus 5 those on Progesterone 6 cigarette smokers 7 those with uremia 8 those with liver disease 9 and the physical inactivity Besides exercise and medications, diet plays an integral part in the production of HDL cholesterol. Low fat, high fiber and reduced polyunsaturated fat all contribute to an elevated HDL2 plasma level. Alcohol in restricted amounts also affects these levels of HDL2. Moderate alcohol consumption actually reduces the risk of coronary events. All forms of alcohol have a beneficial effect but red wine is preferable because of its content of tannin. Excessive alcohol intake (greater than 4-8 oz per day) actually reverses these beneficial effects. Also, excessive alcohol intake increases the chances of acquiring several types of cancer including prostate and breast.

Aspirin

Recent studies have suggested that a low dose aspirin (81 mg/day) may have significant beneficial cardiac and cerebrovascular effects in all patients consuming this drug. Aspirin, when taken consistently over a period of 2-4 years, has recently been shown to reduce the occurrence of melanoma in women by 35%. This is especially true for Caucasian women born in the south who are at the highest risk. The dosage of aspirin is critical. Eighty-one milligrams of aspirin per day will inhibit platelet aggregation but 325 mg/day, while inhibiting platelet aggregation, will also inhibit vascular wall prostacyclin production thus cancelling some of aspirins beneficial effects. There have been six major aspirin studies evaluating low dose aspirin post myocardial infarction. This dose of aspirin reduces recurrent myocardial infarction from 11 to 30%. When combining all the available studies, aspirin reduces myocardial infarctions by 21%. Furthermore, low dose aspirin (81 mg) reduces death from all causes by 16% (p <.01). It is important to remember that platelet thromboxane is exquisitely sensitive to aspirin. Forty milligrams of aspirin will inhibit thromboxane B2 by 70% including bone marrow platelets. On the other hand 81 mg of aspirin will not affect saphenous vein prostacyclin production, but 325 mg will totally inhibit this venous prostacyclin production which produces its antithrombotic and vasodilation function.

Cigarettes

The final major contributing factor to our early demise is cigarette use. Smoking (20 cigarettes/day) increases all cause mortality and morbidity by 50% after 20 years. These causes of mortality and morbidity include lung cancer, pulmonary disease, atherosclerotic heart disease, circulatory disease, and other neoplasms. Even after 20 years of abstinence, the effects of cigarettes can still be seen.