COMMENTARY

5 Ways to Prevent Death in Middle Age

David Kerr, CBE, MD, DSc, FRCP, FMedSci

Disclosures

November 11, 2013

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Hello. I am David Kerr, Professor of Cancer Medicine at the University of Oxford, United Kingdom, and past president of ESMO (European Society for Medical Oncology). Today I want to make a part-medical/part-philosophical proposal: that death in old age is, of course, inevitable, but death in middle age is not.

I have said many times before in this forum that as I have matured as a cancer physician, I have become, in many ways, more a public health physician and much more interested in prevention than I ever had been earlier in my youth as I built my career. Therefore, I was very interested in a study[1] that was published recently by a friend, Professor Peter Elwood, who is at the School of Public Health at the University of Wales in Cardiff. He has done a remarkable piece of work observing a large cohort of Welsh men for over 30 years. By carefully monitoring patterns of behavior -- smoking, alcohol consumption, and so on -- he has mapped these behaviors onto the risk of developing cardiovascular disease, diabetes, dementia, and, of course, cancer. He showed that if we live well, if we choose to live well, then we can have remarkable reductions in the risk of developing all those types of diseases.

The 5 Longevity "Virtues"

There are 5 basic types of good behavior: regular exercise, not smoking, alcohol consumption within guidelines, maintaining a low BMI (body mass index), and eating a predominantly plant-based diet. Thus, if one practices 4 or 5 of those "virtues," compared with men who practice none, the reduction in the risk for cardiovascular disease is around 67%; the reduction in the incidence of diabetes is 73%; the reduction in developing cancer is 20%-25%; remarkably, the reduction in dementia is 65%; and the reduction in all-cause mortality is 32%. Most of the reduction in cancer risk was related to smoking, and frankly the other forms of behavior in this cohort did not affect the development of cancer very remarkably.

But think of that: If one makes the appropriate choice, if one can persuade one's fellows, one's countrymen to make these sorts of choices, then the reduction in disease burden is remarkable -- reduction in dementia risk by 65%. These reductions are not confined to the Welsh, lovely people that they are. Very similar outcomes have been found in large studies in the United States and elsewhere in Western Europe.[2]

To return to my original proposal, the one sure thing in the universe is that we all die -- sad but true. But death in middle age, so common when I was growing up, with my parents who died in their fifties, may no longer be inevitable; many deaths in middle age are preventable.

Let us as physicians set an example. Let us live well. Let us proselytize. Let us promulgate. Let us gather disciples around us. Let us be helpers, public health physicians, and see what we can do to promote a healthier lifestyle, because the rewards are real and they are significant.

As always, thanks for listening. I will be happy to take your comments. Medscapers, ahoy!

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