Live sensibly and live longer

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Two journal reports out this week suggest that even for folks with heart disease or diabetes, with a little lifestyle change, it's not so hard to live to your 90s or even 100.Yet another report in the same Archives of Internal Medicine, though, concludes that after 40 years of improvement, the rate of death from heart disease in the United States may be on the rise again.So are we doing better at evading the Grim Reaper or not? And how much does it have to do with the health care we get, or our income, or our genes, for that matter?The answer seems to be that lifestyle, and managing chronic conditions well enough not to become disabled, are most responsible for people joining and staying in the fastest growing segment of seniors, the 85-and older set. That includes 55,000 centenarians.Of course, one key to living to very old age is to reach the Social Security and Medicare years in reasonably good shape to start with. For instance, researchers at Brigham and Women's Hospital in Boston estimated in their study that a 70 year-old man who did not smoke, had normal blood pressure, normal weight, no diabetes and exercised two to four times a week had a 54 percent shot at living to age 90.Drop the exercise and the odds fell to 44 percent. With high blood pressure, chances dropped to 36 percent. Obesity cut the likelihood to 26 percent; smoking to 22 percent. Combining any three or more of the risk factors dumped the odds even lower."It's not just luck, it's not genetics, it's lifestyle," said Dr. Laurel Yates, who headed the all-male study of more than 2,300 individuals starting in 1981.The second study looked at 739 men and women aged 97 and older. Most of them (68 percent) said they had not suffered from illness typically associated with aging -- such as heart disease, stroke, or lung dysfunction, until they were at least 85.But the rest of the very old crowd, despite becoming ill earlier, still maintained about the same levels of function and independence as those who had delayed the onset of illness well into their 80s. So it may be that avoiding disability is actually more important for a long life than avoiding illness, at least as long as the illness isn't too severe.Up in Olmsted County, Minn., the focus of a study that also began in 1981 was on people who were younger than 64 (and older than 16), who died of unnatural causes and were autopsied to find out why they died. Researchers at the Mayo Clinic used information from the pathology reports and death certificates to assess the condition of the coronary arteries in the deceased -- a total of 425 people through 2004.Over the years, 83 percent of the dead showed some evidence of clogging in one or more heart arteries, and 8.2 percent had severe disease. During the '80s and '90s, the severity of those clogs showed a steady decline. That ended in 2000, and in the first four years of the new century, started becoming worse.Olmsted County's murder, accident and suicide victims may not be exactly the same as Americans everywhere, but the researchers say the condition of their arteries does not bode well for the rest of the country.They can't prove it with just 400 victims, but they strongly suspect that the surge in obesity and diabetes among American adults, and the decline in activity, have a lot to do with the increased clogging of arteries in the young. The study also raises doubts that as many as a million Americans will reach age 100 by 2050 as predicted.On the Net: http://archinte.ama-assn.org/