The 3 Hallmarks of Aging
The Future is Now: Slowing Down & Reversing Disease & Aging
I will review the science of aging and what we can potentially do about it as well as what technological advances are occurring right now.
The three most common hallmarks of aging are cardiovascular disease, cancer, and neurocognitive decline.
Once we have any one of those diseases, we engage in the healthcare system. Let's face it, health insurance is disease insurance or payments related to the disease. In our modern society, healthcare is disease care.
It is not my intention to criticize modern healthcare; I am simply laying out the facts. Most healthcare expenditures and efforts are used in the management of disease, not prevention.
1) Cardiovascular Disease: Detecting Before a Heart Attack
We know we have cardiovascular disease when we have a heart attack or stroke, or some early warning signs such as angina or TIA (transient ischemic attack or a mini-stroke).
But what if you could detect your relative risk of developing a heart attack or stroke years in advance?
We know your doctor uses a combination of assessing your risk factors such as family history, weight, lifestyle factors such as smoking, and very rudimentary tests such as cholesterol level.
We have been doing this for decades, and although we might put off heart attacks a few years, the rate of death from heart attacks is the same as it was 50 years ago.
There are about 800,000 heart attacks a year, and one in five of those heart attacks are silent, meaning the person did not know they had a heart attack.
In people less than 65 years old, about one in four deaths every year are from heart attacks or stroke and two of 10 deaths every year are from cardiovascular disease.
We have the technology available now to predict who is healthy, and who is likely to progress at a faster rate than the general population when it comes to developing a heart attack or stroke.
What is a Calcium Score?
This CAT scan measures the number of calcium deposits in your coronary arteries or the arteries around your heart. This is a perfectly accurate test for predicting future cardiovascular disease compared with people of your age and sex. A problem with a calcium score is that it is less accurate in women and African Americans. Additionally, the calcium score cannot be used to determine the regression of cardiovascular disease accurately.
CIMT (carotid intima-media thickness) is an ultrasound that measures the wall thickness of the arteries in your neck. The thickness of these walls predicts the likelihood of you developing cardiovascular disease in the future. This technology also allows your results to be compared to other people of your age and sex. Additionally, this ultrasound picks up plaques or hardening of the arteries which we can use to track progression or regression of cardiovascular disease.
There are two aspects of the CIMT. One is the thickness of the wall compared to other people like you. A thicker wall means more cardiovascular disease and a thinner wall means less. The second aspect of the CIMT is the plaque or areas of hardening. If you have plaques in the carotid arteries, you are at more risk for developing cardiovascular disease.
Both the thickness of the wall and the amount of plaque can be tracked over time to see if you are getting better or worse in your risk of developing cardiovascular disease. In other words, if you have cardiovascular markers such as a thicker wall or plaques, with management targeted directly towards reversing heart disease when successful, the wall will become thinner, and the plaques will shrink.
The Future of Genetic Testing
What do your genes say about your risk of developing cardiovascular disease? More targeted therapies to reduce the risk of cardiovascular disease can be spelled out in your genetic code.
This testing is not covered by insurance because it is not considered cost-effective compared to current approaches of treating heart attacks and strokes when they occur, as well as treating people with elevated cholesterol medications regardless of knowing whether they will benefit.
It is well known that with conscientious effort, early cardiovascular disease can be reversed. This is a combination of lifestyle changes and medication therapy. This can be guided by understanding your genes and knowing where you're at right now.
2) Cancer: Preventing in Advance with MRIs
We already do screening for common cancers such as skin cancer, breast cancer, colon cancer, cervical cancer, and prostate cancer. This screening does have an impact on reducing mortality from these common cancers. However, we all know someone who died of a less common cancer such as pancreatic, sarcoma, ovarian cancer, bone cancer, brain cancer, liver cancer and lung cancer.
The purpose of cancer screening is not simply to tell you if you have cancer or not, but to tell you as early as possible so you can seek medical treatment. There is a clear link between detecting cancer early in surviving versus detecting cancer in late stages and dying.
Full-body MRI is the term used to do an MRI of the brain, the abdomen, and the pelvis as well as an MRI or CAT scan of the chest. This type of examination is the ability to detect cancers in the early stages that are not detectable with conventional means as well as vascular abnormalities such as aneurysms.
The purpose for consideration of full-body MRI is to detect diseases in the earliest stages. Insurance does not cover this because it is not considered cost-effective versus the wait-and-see approach that healthcare currently uses for less common cancers and diseases.
Genetic testing can also be done to determine what types of cancers you are most at risk for.
3) Neurocognitive Decline (Dementia & Alzheimer’s)
There is a gene called APOE that can predict the risk of developing Alzheimer's disease. APOE 2 genes mean a lower risk of Alzheimer's. APOE 3 means an average risk of Alzheimer's, APOE 4 means an increased risk of Alzheimer's (about 20% of the population has APOE 4).
An early predictor of dementia or Alzheimer's disease is the size of the hippocampus, a structure in your brain. As the hippocampus shrinks your risk of getting dementia increases. This can be measured with an MRI of the brain.
If you are at risk for Alzheimer's because of your genetics, or your hippocampus has shrunk compared to other people your age there is action you can take. There is a concept called neuroplasticity where you can restore the volume of your hippocampus to a more youthful level.
In my opinion, these are the three most important hallmarks of extending our healthspan. Knowing your risks, knowing where you're at right now, then targeting therapies and lifestyle changes specifically aimed at what you are most at risk of developing.
If we can detect the presence of cardiovascular disease well in advance of developing a heart attack, or detecting cancers before they get out of hand, or seeing who is at risk for neurocognitive decline, we can live healthier lives. There is no doubt that exercising and eating right and going to your doctor for routine screening are all beneficial.
Modern technology has given us so many things, yet healthcare tends to lag and is dictated by insurance companies, the government, and big pharmaceutical manufacturers. However, you still have the choice to make your own decisions when it comes to your health.
In future blog posts, I will review breakthroughs that are occurring right now on slowing down or reversing aging. In the meantime, we need to keep ourselves healthy because the technology and medications for antiaging are right around the corner, and in some cases are already here.
Dr. Charles Mok