Women and Longevity

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Women and Longevity

• Medical Secrets to a Long Life

Phyllis August, MD, MPH
Ralph A. Baer, MD Professor of Medicine in
Research Weill Medical College
of Cornell New York
Presbyterian Hospital
The fountain of youth
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The River of Immortality
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Ponce de Leon and the Search for the Fountain of
Youth 16th
Century
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Health and Beauty Spa 2008
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Women and Longevity

• How long do women live?
• How well do we age?
• What are the determinants of living long and
  well?
• What are the major causes of death
• How do we prevent premature death and disability

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How Long Do Women Live?
She was a handsome woman of forty-five and would
remain so for many years. Anita Brookner
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Recorded female life expectancy from 1840 to the
present (1)
Westendorp, R. G
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How Well Do Women Age?

• You can only perceive real beauty in a person as
  they grow older Anouk Aimee

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To die young, as late in life as possible

• Ancient Greek saying

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Successful Aging of the Population

• By 2040 40 million persons 85 yrs
• Ages 74-84 - 75 report no disability
• Age 85- 40 are fully functional

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What happens with Age

• Deterioration hearing, smell, eyesight
• Change Gray hair, thick waist, decreased sexual
  activity
• Development and maturation tolerance, patience,
  acceptance

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Berlin Aging Study(500 urban Berliners)

• 70 yrs most will have a serious illness and
  arthritis
• Up to age 95 only 10 had dementia
• IQ at 75 is the same as age 20
• 85 of those age 75 were in good health

Baltes 1999
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Greater Longevity is associated with less
disability
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Coping Strategies and Aging

• Depression is not increased in elderly
• Elderly do not perceive themselves as sick
• Spirituality and serenity increase with age
• Education and extended family predict aging well

Baltes 1999, Berlin Aging Study
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What Can Be Done to Age Better?

• To know how to grow old is the master work of
  wisdom, and one of the most difficult chapters in
  the great art of living
• Henri Frederic Amiel

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Study of Adult Development(Vaillant and Mukamel)

• Harvard students and inner city boys born between
  1918 and 1932
• 60 years follow up
• Subjects classified as happy-well intermediate,
  sad-sick, prematurely dead

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Predictors of Healthy Aging

• Not smoking
• Absence of alcohol abuse
• Normal weight
• Regular exercise
• Stable marriage
• Mature coping mechanisms
• Level of education
• Absence of Depression

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Centenarians Living to 100(New England
Centenarian Study)

• 1 in 10,000
• 85 female, 15 male
• Centenarians escape lethal diseases, and
  experience less disability from non lethal
  diseases
• Females have more age related illnesses compared
  to men
• Females survive these illnesses at a greater rate

Thomas Perls, MD, MPH
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What are the determinants of longevity?

• Genetics 25-35 - decreased susceptibility to
  age related diseases including heart disease,
  cancer, diabetes
• Environment diet, exercise, smoking, moderation
  in alcohol intake, maintaining normal weight

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What are the Leading Causes of Death?

• Cardiovascular disease
• Cancer
• Stroke

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What is Cardiovascular Disease?
Cardiovascular disease (or CVD) includes heart
and blood vessel diseases diseases that affect
the circulatory system.        
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Examples

• Coronary heart disease (heart attack)
• Cerebrovascular disease (stroke and TIA)
• Congestive heart failure
• Congenital cardiovascular defects
• Peripheral vascular disease

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Cardiovascular Disease Leading Cause of Death in
Women

• Cardiovascular disease kills over 460,000 women
  per year about one woman per minute
• CVD kills more women than the next 5 causes of
  death combined
• One woman in three has some form of CVD

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American Heart Association Survey of Women and
Heart Disease

• Cancer still perceived as womens leading health
  problem
• Women under age 45 had lower awareness that heart
  disease is womens No. 1 killer
• Women know of CVD risk factors in general but
  often not their own risks

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Risk Factors for Cardiovascular Disease

• Hypertension
• Diabetes
• Smoking
• Cholesterol
• Menopause

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HypertensionResponsible for Half of all CV
Deaths

• Hypertension, (high blood pressure)
• pressure in the arterial circulation
• Normal blood pressure
• systolic 100-120 mm Hg
• diastolic 70-80 mm Hg
• High blood pressure
• 140/90 mm Hg
• higher levels greater risk

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Global Burden of Hypertension1 billion 2000,
1.5 billion 2025
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Prevalence of Hypertension in the US 50 million
Population,

Age, y
Age (years)
NHANES III, National Health and Nutrition
Examination Survey. Data not available
prevalence estimates for women aged 20-34 years
are considered unreliable. Source Health, United
States, 2003, CDC/NCHS.
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Hypertension IncreasesCardiovascular Disease and
Death


Heart Disease Rate
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Treatment of Hypertension Prevents Strokes, heart
attacks, kidney failure and death
Heart Disease and Death
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Poorly Treated Hypertension Impairs Cognitive
Function

• Hypertension is a cause of dementia
• Hypertension worsens preexisting dementia
  (including Alzheimers Disease)
• Hypertension causes subtle progression of
  cognitive decline
• Treatment of hypertension prevents dementia

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You Can Lower Your Blood Pressure Without Drugs

• maintain ideal body weight
• regular aerobic exercise
• diet fruits, vegetables, low fat, high fiber,
  low salt
• moderate alcohol
• no smoking!

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Blood Pressure Lowering Medications

• Overwhelming evidence that they save lives
• Blood pressure should be less than 140/90 mm Hg
• Use whichever drug works and which has the fewest
  side effects

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Hypertension is the most easily treatable risk
factor for cardiovascular disease and death
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Cholesterol

• Dietary cholesterol animal fats
• Strong genetic component
• Excess cholesterol leads to atherosclerosis
  (hardening of the arteries) and cardiovascular
  disease

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Do You Know Your Total Cholesterol Numbers?

• Less than 200 mg/dl (5.18 mmol/L) Desirable
  (lower risk)
• 200239 mg/dL Borderline high (higher risk)
• 240 mg/dL and above High blood cholesterol,
  more than twice the risk than the desirable level
• HDL (good cholesterol) is also
• important, especially for women.
• Goal above 50 mg/dl

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Smoking

• Smoking is the single most
• preventable cause of death in the US
• 18.5 percent of American women age 18
• and older smoke
•         

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Smoking

• If you dont smoke, dont start
• If you smoke, quit
• Avoid others tobacco smoke

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Physical Inactivity

• Increases heart disease and stroke risk
• 30 minutes or more of activity on most or all
  days of the week helps
  reduce risk! It
• Controls blood cholesterol
• Controls diabetes and obesity
• Helps lower blood pressure

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Obesity / Overweight

• Overweight/obese women 20 and older
• American Females 60

2007
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Even the French are fighting obesity Herald
Tribune 2005

• 11 in France, compare with 30 in US
• Increasing at a rate of 5 per year
• Particularly in the young
• Fast food, lack of exercise, shorter family meals

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Diabetes

• Women age 20 and older with diabetes
• White females 5.6
• Diabetes doubles risk for heart disease
• Strongly associated with overweight and lack of
  exercise

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What Is Diabetes?

• A progressive disease in which your body doesnt
  make enough insulin / doesnt respond properly to
  it
• Insulin regulates the blood sugar (glucose)
• Goal fasting glucose below 100 mg/dl

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Why Is Diabetes Bad?

• At least 65 of people with diabetes die of some
  form of CVD
• Diabetes lowers good cholesterol, and raises
  bad cholesterol and triglyceride levels
• Many people with diabetes also have high blood
  pressure and are overweight

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Heart Attack Warning Signs

• Most common heart attack symptom is chest pain or
  discomfort
• Women are more likely than men to experience
• Pain or discomfort in one or both arms, the back,
  neck, jaw or stomach
• Shortness of breath with or without chest
  discomfort
• Profound fatigue
• Cold sweat, nausea, vomiting or lightheadedness

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What About Cancer?

• Breast cancer
• Lung cancer
• Colorectal cancer

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Cancer Screening and Prevention

• Breast routine mammography
• Lung dont smoke ?screening with CT scans
• Colorectal high fiber diet, routine colonoscopy
  age 50

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Secrets to Longevity

• He who does not know food, how can he understand
  the diseases of man?
• Hippocrates, the father of medicine (460-357 BC)

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What is a Healthy Diet?

• Whole, unprocessed foods
• Vegetable, fruits
• Plant based fats and proteins
• Fiber
• Whole grains

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Secrets to Longevity

• Exercise regularly 30 minutes daily, include
  strength training
• Drink water alcohol in moderation, dont smoke
• Stay involved and connected to loved ones

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What about Antiaging Therapy?

• Growth hormone, DHEA, testosterone no proven
  benefits and may be dangerous
• Hormone replacement therapy for women
  controversial
• Vitamins and supplements Vitamin D,
  multivitamins, Omega 3 fatty acids

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What About Fad Diets ?

• Avoid diets that overemphasize one nutrient over
  another
• Not all carbs are bad
• Unprocessed, natural food is better than vitamins
  or supplements

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Old age isn't so bad when you consider the
alternatives Maurice Chevalier
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With mirth and laughter let old wrinkles come
Shakespeare

• Merchant Of Venice