There is substantial evidence demonstrating that each of us have the ability to reduce mortality risk by lifestyle choices. Preventive Health Advisor has compiled a collection of research findings that may be easily implemented to potentially increase longevity. Some of this research has been included below:
Anti-aging, Increasing Lifespan, and Reducing Risk of Mortality
Introduction: This data focuses on reducing the risk of both mortality and the major causes of death using mainly non-pharmacological medicine. The research included here includes a collection of data relevant to mortality reduction. According to the Centers of Disease Control as of 2010, the top 15 causes of death in the United States include heart disease, cancer, chronic lung disease, stroke, accidents, Alzheimer’s disease, diabetes mellitus, kidney disease, influenza/pneumonia, suicide, sepsis, chronic liver disease, hypertension, Parkinson’s disease, and aspiration pneumonia. This information will be updated and reinforced on a continual basis as new data becomes available.
Reducing risk of mortality in heart disease:
The American Heart Association (AHA) and ideal cardiovascular health: The AHA explained ideal cardiovascular health should be obtained by targeting 7 behaviors that reduce the likelihood of cardiovascular disease or stroke. They include 4 core behaviors—no smoking, a normal body mass index (BMI), engaging in physical activity, and eating healthfully—and meeting at least 3 of the following criteria: cholesterol lower than 200 mg/dL, blood pressure lower than 120/80 mm Hg, not having diabetes, or being free of heart disease. To assess the effects of meeting these targets on risk of death from cardiovascular disease, Artero and colleagues looked at data from the Aerobics Longitudinal Study, conducted in 11,993 patients between Oct. 9, 1987 and March 3, 1999. The authors found that those who met 3-4 of AHA’s “Simple Seven” heart-health criteria had a 55% lower risk of cardiovascular mortality than those who met no more than 2 of those practices over about 11 years. It was 63% lower for those who fulfilled five to seven of the ideal criteria compared with those with the lowest scores. The overall prevalence of ideal cardiovascular health was extremely low in this middle-aged cohort, with only 0.2% of patients meeting all 7 criteria. (1)
U.S. Preventive Services Task Force (USPSTF) aspirin recommendations:
For the use of aspirin in prevention (45):
Aspirin dosage:
According to the USPTF, the ideal dose of aspirin is not known, but a dose of 75 mg per day appears as effective as higher doses and may have less risk of gastrointestinal bleeding.
Men benefit from aspirin for the prevention of cardiovascular disease:
Men younger than 45 years:
For myocardial infarction prevention in men younger than 45 years the USPSTF recommends against the use of aspirin since the benefit for prevention of cardiovascular events are small.
Men age 45 to 79 years:
The U.S. Preventive Services Task Force (USPSTF), strongly recommends the use of aspirin when the potential benefit due to a reduction in myocardial infarctions is more beneficial than the potential harm due to gastrointestinal hemorrhage.
Men and Women 80 years of age and older:
According to the U.S. Preventive Services Task Force (USPSTF), there is insufficient evidence to determine the risk verses benefit of taking aspirin by men and women over 79 years of age for the prevention of cardiovascular disease.
Aerobic exercise and coronary artery disease:
Aerobic exercise (with a cardiac rehab program if required) reduces mortality in coronary artery disease. A systematic review and meta-analysis of randomized controlled trials by Taylor et al found that exercise based cardiac rehabilitation reduces all cause and cardiac mortality and improves a number of cardiac risk factors in patients with coronary heart disease according to this meta-analysis of 48 randomized controlled trials (RCTs) (8940 patients, mean age 55 y). Intervention duration ranged from 0.25–30 months and follow up was between 6–72 months. Patients who received exercise-based cardiac rehab had a significant reduction in all cause mortality of 20% and cardiac mortality of 26% than did patients who received usual care. Groups did not differ for rates of non-fatal heart attack (odds ratio [OR]= 0.79), coronary artery bypass grafting (OR=0.87), or percutaneous coronary intervention (OR=0.81). Cardiac rehabilitation was associated with significant reductions in total cholesterol of 0.37 mmol/L and triglyceride concentrations by 0.23 mmol/L; no significant differences were seen in low ‘bad’ or high-density ‘good’ lipoprotein concentrations. Systolic blood pressure was significantly reduced by 3.2 mm Hg. A significant 36% reduction in patient smoking was reported with cardiac rehabilitation. (2)
Nine lifelong cross-country skiers, with a mean age of 81 years and a history of aerobic exercise and participation in endurance events throughout their lives, were examined to determine whole body aerobic capacity and myocellular markers of oxidative metabolism. A cycle test was used to measure aerobic capacity (VO2 max) and a resting vastus lateralis muscle biopsy was used to measure oxidative enzymes associated with muscle health. Six age-matched, healthy, untrained men were used as a comparison. Results indicated that the athletes had a higher absolute (2.6 vs. 1.6 L•min(-1)) and relative (38 vs. 21 ml•kg(-1)•min(-1)) aerobic capacity, heart rate (160 vs. 146 b•min(-1)), and final workload (182 vs. 131 watts). Among athletes, muscle oxidative enzymes were 54% (citrate synthase) and 42% (βHAD) higher. In summary, compared to their counterparts, the life long athletes had better cardiovascular and skeletal muscle health that was associated with lower risk for disability and mortality. (3)
Alcohol use and cardiovascular mortality:
Alcohol use reduces risk of cardiovascular mortality with light to moderate use. The ideal amount of alcohol consumption in order to obtain benefits of reduced risk for a number of disease states appears to be 2-4 drinks per day for men and 1-2 drinks per day for women. (4)
Drinking alcohol has a protective effect on cardiovascular disease according to a study in Australia. Men who consumed light-to-moderate amounts of alcohol at 3–4 or 5–7 days per week had decreased risks of myocardial infarction and ischemic stroke compared with men who consumed alcohol less than once per week. Moderate alcohol drinking decreases the risk of cardiovascular disease by about 25%, which is linked to a decrease in the total cardiovascular disease burden in Australia of 4.7%. In Australia, 34% of the total number of deaths in 2008 were from cardiovascular disease and in 2003, it was 18% of the overall burden of disease (coronary heart disease and stroke contributed over 80% of this burden). (5)
A study done in Copenhagen, Denmark followed 6051 men and 7234 women between 30 and 70 years old. The relative risk of cardiovascular mortality was significantly less for those who had a low to moderate intake of wine. It was found that beer intake did not change mortality risk much and that drinking spirits increased mortality. (6)
Alcohol intake may increase good cholesterol (HDL). It is believed that HDL increases from alcohol beverages are responsible for 50% of the protective effect from coronary artery disease. The other 50% level of protection may be due to polyphenols in red wine which inhibit platelet aggregation. (7)
Beta-carotene in food vs. supplements and heart disease:
Intake of vegetables containing beta carotene was associated with a lower risk of cardiovascular mortality and with a lower risk for all causes of death but no benefit was seen with taking beta-carotene supplements. Greenberg ER et al tested beta carotene levels in subjects prior to being randomized to take beta carotene supplements. Subjects with an intial beta carotene level of 0.34 to 0.52 umol/L had a 43% less risk of death from cardiovascular disease when compared to subjects with the lowest intial beta carotene levels of under 0.21 umol/L. Those subjects with an intitial beta carotene level of over 0.52 umol/L had a lower risk of death from all causes. There was no reduced risk of disease or mortality benefit in subjects who took beta carotene supplements in pill form. (8)
Beta-carotene supplements are not advised among healthy individuals, unless they suffer from or are at risk of vitamin A deficiency. Beta-carotene supplementation results in a greater increase of beta-carotene blood concentration than beta-carotene rich foods. A 20 mg/d supplement of beta-carotene can result in blood concentrations high enough to increase a patient’s risk of lung cancer, while the same quantity obtained from foods was not associated with lung cancer risk. Additionally, 30 mg/d of beta-carotene supplement was associated with blood concentrations 5 times greater than that of 29 mg/d of beta-carotene from carrots. The consumption of 5 or more daily servings of fruits and vegetables is recommended by “National Cancer Institute’s Five-A-Day for a Better Health program” and “Canada’s Food Guide for Healthy Eating.” Eating a variety of 5 fruits and vegetables per day provides the individual with about 5.2 to 6 mg/day of food based beta-carotene. This allows plasma carotenoid levels to rise above a range represented in studies which were associated with a lower risk of coronary heart disease and all-cause mortality compared to those with a lower food based carotenoid levels. (9)
The Beta-Carotene and Retinol Efficacy Trial (CARET), showed that among 18,314 men and women who smoked heavily or were exposed to asbestos, daily intake of 30 mg (100,000 IU) of beta-carotene and 25,000 IU vitamin A failed to decrease the risk of heart disease. The study was stopped early because it showed that beta-carotene/vitamin A takers who were heavy smokers, ex-smokers or asbestos workers were showing a 28% increased risk of lung cancer in smokers (versus placebo) and a 17% more likely chance of dying, mostly of lung cancer or heart disease. Results of a 6-year follow-up of study participants showed that compared to the placebo or no intervention group, participants who had taken the intervention had a 12% and 8% increase in relative risk of lung cancer and all-cause mortality among the intervention group, respectively. Researchers also found that after the intervention was stopped relative risk of cardiovascular disease mortality dropped and there was no difference in risk between the two groups. Finally, they found that women were more affected by the supplements with a larger relative risk of cardiovascular disease mortality (1.44 versus 0.93; P = .03), and all-cause mortality (1.37 versus 0.98; P = .001) than males. (10)
According to Martini et al in the University of Minnesota Cancer Prevention Research Unit Feeding Studies, an intake of 5 mg per day of beta carotene was required to establish beta carotene levels to a plasma level of 0.37 umol/L. When food based beta carotene was consumed in the form of about 1.5 cups of carrots, and about 0.9 cups of spinach which equated to just over 42 mg of beta-carotene per day, levels increased to 0.83 umol/L. (11)
Beta-carotene in foods:
For a breakdown of concentration of beta-carotene in foods, please see: Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. This may be accessed at: https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w321.pdf and http://www.nal.usda.gov/fnic/foodcomp/Data/HG72/hg72_2002.pdf
A meta-analysis that included 78 randomized clinical trials was conducted to determine the relationship of oral antioxidant supplementation (beta-carotene, vitamin A, vitamin C, vitamin E, and selenium) and mortality. Mean duration of supplementation was 3 years. When all of the trials were combined, and the analysis that is typically used when similarity is present was conducted (fixed-effect model), antioxidant use did slightly increase mortality. When the trials with low risks of bias were considered, the patients consuming the antioxidants had a 4% higher risk of death compared to those taking placebo or no intervention (relative risk [RR]=1.04). The increased risk of mortality was significantly associated with use of beta-carotene (death rate: 13.8% on supplement vs 11.1% on placebo; RR=1.05) and vitamin E (12.0% vs 10.3%; RR=1.03) and possibly vitamin A, though the relationship was not significant with a 14.0% death rate among those taking vitamin A compared to a 13.6% death rate among placebo subjects. The current evidence does not support the use of these antioxidant supplements in the general population or in patients with various diseases. (12)
The research mentioned thus far on beta-carotene suggest a lower risk of mortality stems from beta carotene intake from food sources but not beta-carotene supplements. The benefit may also come from other substances in the vegetable food source and not necessarily the beta carotene itself.
Vitamin D and heart disease:
Investigators followed a total of 1,194 men over a median duration of 12.7 years in this longitudinal study looking at the link between blood levels of vitamin D and mortality. They looked at vitamin D levels and cardiovascular-related as well as all cause mortality. There was a clear U-shaped curve when looking at the relationship between vitamin D levels and all-cause mortality along with cancer-related mortality, meaning the risk of mortality was significantly increased at both low and high blood levels of vitamin D. In this study, the range with the lowest mortality was about a vitamin D concentration of 24 to 34 ng/ml (60 to 85 nMol/L), which approximately translates to a vitamin D dose of 2000 IU/d. In general, the biggest drop in overall death rates were seen when subjects went from being vitamin D deficient to reaching adequate levels. However, too much vitamin D translated into a gradual increase of mortality rate with cancer deaths rising significantly for the highest levels of vitamin D intake but no increase in cardiovascular mortality was seen. There was a sharp drop in cardiovascular related death rates as study participants went from being vitamin D deficient to approaching a level of 26 ng/ml. At this point there was a leveling off with no added benefit or increase in mortality seen with higher vitamin D levels. Men with low concentrations of vitamin D had a higher cardiovascular mortality. Overall mortality was increased by 50–60% among subjects in the lowest 10% and highest 5% of the vitamin D distribution, whereas cardiovascular mortality was increased only in the bottom 10%. The ideal vitamin D dose according to findings in this study is 2000 IU/d. (13)
Vitamin D is important for reducing the risk of heart disease. A report by the Institute of Medicine (IOM) and the Endocrine Society’s Clinical Practice Guidelines tripled the amount of vitamin D required for most children and adults. The Endocrine Society’s Clinical Guidelines for vitamin D concluded that vitamin D deficiency be defined as a 25(OH)D < 20 ng/ml, insufficiency as a 25(OH)D of 21–29 ng/ml and sufficiency as a 25(OH)D of 30–100 ng/ml. For preventing and treating vitamin D deficiency the Guidelines recommended vitamin D intake should be: children < 1 y 400-1,000 IU/d, children 1-18 y 600-1,000 IU/d and adults 1,500-2,000 IU/d to maintain 25(OH)D concentrations of 40–60 ng/ml. Upper limits of vitamin D intake were also set as follows: 2000 IU/day for children up to age 1 year; 4000 IU/day for children aged 1 – 18 years, and up to 10,000 IU/day for adults aged 19 years and older. The IOM report concluded that dietary and supplemental vitamin D intake is adequate to satisfy both children and adult, but their study suffered from serious flaws. A study (Moore et al) suggests that neither children nor adults in the US are obtaining the new RDA for vitamin D. Among women vitamin D intake from food was 156–208 IU/d and with supplements 244–324 IU/d. For men, corresponding values were 208–320 IU/d and 308–392 IU/d. There is no evidence that there is a downside to increasing vitamin D intake in children and adults, with the exception of those with chronic granuloma forming disorder or lymphoma in which high vitamin D levels may occur resulting in high calcium levels. (35)
Vitamin C and heart disease:
Vitamin C and heart disease: Carr and Frei recommended a higher vitamin C intake of 90-100 mg per day to avoid chronic diseases. They found prospective studies which demonstrated that a low vitamin C poses a higher risk of cardiovascular disease. (43)
This analysis, was conducted on 19,496 men and women, ages 45 to 79, in the U.K. The participants’ blood was tested for ascorbic acid (a form of vitamin C) and they were placed in five groups (quintiles) according to their serum ascorbic acid levels. Men and women were tracked separately. The researchers observed how many people died of cardiovascular disease, ischemic heart disease, cancer, and all causes in each of the blood ascorbic acid quintiles. In every case (except for women at risk of cancer), death rates were significantly lower among those with higher blood ascorbic acid levels. People with the highest ascorbic acid levels had half the risk of dying from all causes combined. Additionally, a 20 micromol/L increase in blood ascorbic acid concentration, the same as a 50 g per day increase in fruit and vegetable intake, was associated with about a 20% reduction in risk of all-cause mortality. (14)
Vitamin C has been shown to be beneficial for people with certain diseases or conditions. High intakes of vitamin C have been associated with decreased risk of heart disease, cancer, eye diseases, and neurological conditions. High dose vitamin C, with an upper tolerable level set at 2 grams per day set by the USDA has been shown to be safe. This limit was set by the USDA due to gastrointestinal side effects. Among healthy individuals, the recommended daily intake of vitamin C is 75 mg for women and 90 mg for men. (15)
Loria and colleagues found an association between low blood ascorbate (vitamin C) levels and an increased risk of dying, overall and from cancer, among men. Compared to men with high ascorbate blood concentraions (73.8 micromol/L or greater), men with low ascorbate blood concentrations (less than 28.4 micromol/L) have a 57% increased total mortality risk and a 62% increased mortality risk from cancer. No change in risk of mortality was found among men with ascorbate blood concentrations between 28.4 to 73.8 micromol/L. No link between mortality and ascorbate levels were found among women. (16)
Calcium supplements may increase mortality:
Calcium and high-dose calcium supplementation was associated with greater cardiovascular (CV) mortality and all-cause mortality in women according to a prospective cohort study of 61,433 women born between 1914 and 1948. Compared with dietary calcium intakes of 600 to 1000 mg daily, daily intakes of ≥1400 mg were associated with significantly higher rates of death from all causes (40% increased risk), CV disease (49% increased risk), and ischemic heart disease (2 times higher risk), but not from stroke. Among the 6% of participant women using calcium supplements (500 mg), those who were also consuming >1,400 mg/d in their diet had a 2.5-times higher risk of all-cause death than women with similar total intakes not taking a supplement. (36)
Calcium supplements increased the risk of cardiovascular events, especially heart attacks, in older women. A re-analysis of data from the Women’s Health Initiative Calcium/Vitamin D Supplementation Study found that among the almost 16,718 women not taking personal supplements at the time of randomization, being randomized to new supplement use (1g calcium and 400 IU vitamin D daily) was associated with a statistically significant increase in risk of cardiovascular events (heart attack, stroke) ranging from 13%-22%. Among women already taking supplements at the start of the study, no such increase in events was seen. A meta-analysis of 3 placebo-controlled trials found that compared to placebo, calcium and vitamin D increased the risk of heart attack by 21%, stroke by 20%, and heart attack or stoke by 16%. (37)
An analysis of 388,229 individuals aged 50 to 71 years found that high calcium intake was associated with an increased risk of cardiovascular disease (CVD) mortality in men, but not women. At study enrollment, 51% of men and 72% of women were taking some form of calcium. The study found that compared to men not taking calcium, men with calcium intake of 1000 mg/day had an elevated risk of total CVD death (20% increased risk) and heart disease death (19% increased risk) but not cerebrovascular disease. In women, there was no association between calcium supplementation and death from cardiovascular disease or cerebrovascular disease. (38)
Vitamin E and omega-3 oil in cardiovascular disease and mortality:
In a randomized controlled trial in Italy published in Lancet, 11,324 patients with pre-existing coronary heart disease (CHD) were randomly allocated to either 300 mg vitamin E, 850 mg omega-3 fatty acid ethyl esters (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]), both, or no treatment and followed for 3.5 years. In the end, a 15% reduction in mortality, nonfatal heart attack (myocardial infarction), and nonfatal stroke was seen in participants taking 850 mg omega-3 fatty acid alone. Compared to the no treatment group, participants taking omega-3 fatty acid after 6-months experienced a 2.5% increase in HDL (“good”) cholesterol and a 4% reduction in triglycerides, a type of fat in the bloodstream and fat tissue that can contribute to the hardening and narrowing of arteries. As a group, those taking this dietary supplementation experienced a 20% reduction in all-cause mortality and a 45% reduction in sudden death. The results indicate that in patients who have CHD, omega-3 fatty acid supplements, but not vitamin E, significantly reduced mortality. (17)
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Fish oil and mortality:
Vegetarian diet in cardiovascular disease and mortality:
A low carbohydrate, high protein diet and mortality:
Tea consumption and heart disease:
Ischemic heart disease (IHD) and a long acting garlic preparation:
Glucosamine, chondroitin, and mortality:
Coenzyme Q10 levels and survival:
Reducing risk of mortality in cancer:
Aerobic exercise and cancer:
Beta carotene, vitamins, minerals, omega-3 oils, and cancer:
Antioxidant vitamin supplement, cancer, and all-cause mortality:
Beta-carotene and cancer:
Calcium and cancer:
Calcium and breast cancer:
Vitamin D and cancer:
Vitamin C and cancer:
Nutrition, foods and diet related to cancer:
Aspirin use for the prevention of cancer:
Red wine and esophageal, gastric cancer risk:
Colorectal cancer screening:
Reducing risk of stroke related mortality:
Women and aspirin for a lower mortality:
Prevention of ischemic stroke in women:
A calculator for the risk of stroke is available:
Wine consumption and stroke mortality:
Mortality in vegetarians vs. non-vegetarians:
Mortality due to respiratory causes may be reduced by a mineral:
Mortality related to inflammatory disease:
Other possibilities for lifespan and longevity enhancement:
Aerobic fitness and brain volume:
Polyphenols and lifespan:
Assessment and Plan: Anti-aging, Increasing Lifespan, and Reducing Risk of Mortality
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