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The Four Horsemen of Longevity: Understanding illness to increase healthspan (Part 1)

Chronic diseases have a long-lasting effect on individuals of all ages. As discussed in our previous blog post they are the leading cause of worldwide morbidity and mortality, having a profound impact on people's lives, families, and communities. Also, the economic burden of chronic diseases is significant, including increased healthcare expenses, lost productivity, and strain on the healthcare system and public resources.

The Four Horsemen of Chronic Disease are a persistent group of health problems that have become the main causes of death and disability in the developed world:

  • Atherosclerosis

  • Cancer

  • Alzheimer’s and Neurodegenerative diseases

  • Diabetes and Foundational diseases

These health problems have risen after the increase in human lifespan since the past century. The number of individuals suffering from chronic illnesses is predicted to increase dramatically in the coming decades as a result of factors such as aging populations, changing lifestyles, and environmental degradation. Only in the USA the number of people aged 50 and more who have at least one chronic condition is expected to rise by 99.5%, from 71.522 million in 2020 to 142.66 million by 2050.

Managing and -especially- preventing these Four Horsemen is a key factor to increase healthspan and prevent major economic burdens in the near future.

Addressing chronic diseases requires a holistic approach that includes prevention, early detection, and treatment. It is important to promote a healthy lifestyle and reduce risk factors for these diseases. This also requires improved access to healthcare and more effective treatments for these diseases.

This blog post is the first of a two-part series about these health conditions. This section will go through Atherosclerosis and Cancer. In the next issue, we'll go deep into Alzheimer's & Neurodegenerative disorders and Diabetes & Foundational diseases.

1. Atherosclerotic Disease

What Is Atherosclerosis?

Atherosclerosis is a common condition that develops when a sticky substance called plaque builds up inside your artery . Disease linked to atherosclerosis is the leading cause of death in the United States. About half of Americans between ages 45 and 84 have atherosclerosis and don’t know it.

This condition is usually considered a chronic inflammatory disease as inflammation plays an important role in all stages of the atherosclerotic process. Inflammation acts as a common basis for the physiological and pathological changes throughout atherosclerosis initiation and development.

Atherosclerosis develops slowly as cholesterol, fat, blood cells and other substances in your blood form plaque. When the plaque builds up, it causes the arteries to narrow. This reduces the supply of oxygen-rich blood to tissues of vital organs in the body.

This health related problem can affect most of the arteries in the body, including arteries in the heart, brain, arms, legs, pelvis, and kidneys.

Where plaque develops, and the type of artery affected, varies with each person. Plaque may partially or totally block blood flow through large- or medium-sized arteries in the heart, brain, pelvis, legs, arms or kidneys. This can lead to conditions such as:

  • Coronary heart disease (plaque in arteries in or leading to the heart)

  • Angina (chest pain from reduced blood flow to the heart muscle)

  • Carotid artery disease (plaque in neck arteries supplying blood to the brain)

  • Peripheral artery disease, or PAD (plaque in arteries of the extremities, especially the legs)

  • Chronic kidney disease

If a plaque bursts, blood clots may form and block the artery completely or travel to other parts of the body. Blockages, either complete or incomplete, can cause complications, including heart attack, stroke, vascular dementia, erectile dysfunction, or limb loss, potentially causing death and disability.

How to diagnose Atherosclerosis?

To diagnose atherosclerosis, we use various methods, including:

  • Medical History and Family History Assessments,

  • Blood tests : they include checking the levels of cholesterol (HDL and LDL), triglycerides , blood sugar, lipoprotein A, Apo-B lipoprotein, or proteins that are signs of Inflammation , such as C-reactive protein (cardiac CRP),

  • Imaging procedures : such as Angiography, Cardiac MRI, Cardiac positron emission tomography (PET) scanning, and Coronary computed tomographic (CT) angiography.

Beginning at age 20, individuals undergo regular screening to identify risk factors associated with arterial plaque accumulation. These screenings involve checking blood pressure, calculating body mass index, measuring waist circumference to assess weight-related risks, and conducting blood tests to evaluate cholesterol, triglycerides, and blood sugar levels.

Additionally, risk factors should be addressed as early as possible. This includes considering lifestyle habits such as smoking, physical activity, and dietary patterns, as well as personal health history, including conditions like diabetes and inflammatory disorders. Family history also plays a crucial role, particularly if blood relatives have a history of early heart attacks or sudden deaths before the age of 55.

How Do You Prevent Atherosclerosis?

Lifestyle changes: You can slow or stop atherosclerosis by taking care of the risk factors. That means a healthy diet, exercise, and no smoking. These changes won't remove blockages, but they’re proven to lower the risk of heart attacks and strokes. Here you have a list when some advices for prevent this health condition:

  • Get a daily dose of physical activity, such as a brisk, 30-minute walk.

  • Cook meals that are low in sodium and unhealthy fats.

  • Take your medications as prescribed and keep your medical appointments.

  • Sleep 7-8 hours a night.

  • Manage stress through, for example, meditation, yoga, a warm bath, or quiet time with a good book or funny movie.

  • Keep a proactive approach to your diet, increasing fruit and vegetable intake

2. Cancer

What is Cancer?

Cancer is an uncontrolled multiplication and spread of certain cells in the body. It can originate in any part of the human body, which is composed of billions of cells. In normal conditions, human cells form and multiply through a process called cell division to create new cells as the body needs them. Aging or damaged cells die, and new cells replace them.

However, at times, the normal process is disrupted, leading to the formation and multiplication of abnormal or damaged cells when they shouldn't. These cells may form tumors, which are lumps of tissue. Tumors can be cancerous (malignant) or non-cancerous (benign).

Cancerous tumors invade nearby tissues and can spread (or metastasize) to other parts of the body, forming tumors there—a process known as metastasis. Cancerous tumors are also called malignant tumors. Many types of cancer form solid tumors, but blood cancers like leukemia generally do not form solid tumors.

Benign tumors do not spread to nearby tissues. When benign tumors are removed, they usually do not return, whereas cancerous tumors may sometimes recur. However, benign tumors can sometimes be quite large. Some may cause severe symptoms or endanger a person's life, such as benign tumors in the brain or brainstem.

What statistics say about Cancer in the USA?

The American Cancer Society estimates the number of new cancer cases and deaths in the United

States each year and compiles the most recent information on population-based cancer occurrence and outcomes. The United States is expected to see 609,820 cancer deaths and 1,958,310 new cancer cases in 2023. After two decades of reduction, prostate cancer incidence climbed from 2014 to 2019 by 3% yearly, representing an extra 99,000 new cases.

In contrast, other cancer incidence trends were more positive in men than in women. From 2015 to 2019, for example, lung cancer in women reduced at half the rate of males (1.1% vs. 2.6% annually), whereas breast and uterine corpus tumors continued to rise, as did liver cancer and melanoma, which both stabilized in men aged 50 and older and declined in younger men. However, a 65% decrease in cervical cancer incidence among women in their early twenties, the first cohort to receive the human papillomavirus vaccine, from 2012 to 2019, portends substantial reductions in the burden of human papillomavirus-associated cancers, the majority of which occur in women.

What are the risk factors associated with cancer?

Cancer risk factors include exposure to chemicals or other substances and certain behaviors. They also encompass uncontrollable factors such as age and family history. The following list comprises well-studied known or suspected cancer risk factors:

  • Alcohol

  • Diet

  • Age

  • Infectious agents

  • Hormones

  • Chronic inflammation

  • Immunosuppression

  • Sunlight

  • Obesity

  • Radiation

  • Carcinogenic environmental substances

  • Tobacco

How can it be prevented?

Prevention of cancer involves measures taken to reduce the likelihood of developing cancer. Besides the physical issues and emotional suffering caused by cancer, the high costs of care also impose a burden on patients, their families, and the public. Prevention aims to decrease the number of new cancer cases, consequently reducing the cancer burden and the number of deaths due to this disease.

Scientists study various ways to help prevent cancer, including the following:

  • Ways to avoid or control known cancer-causing agents.

  • Changes in diet and lifestyle.

  • Early identification of precancerous conditions, which sometimes evolve into cancer.

  • Chemoprevention (using medications to treat a precancerous condition or prevent cancer from occurring).

  • Surgery to reduce risks

In recent years, sophisticated DNA-based tests for Cancer have become easily accessible, like Galleri®. It can test for 50 different types of Cancer by blood. The Galleri® test looks for cell-free DNA and identifies whether it comes from healthy or cancer cells. DNA from cancer cells has specific methylation patterns that identify it as a cancer signal. Methylation patterns also contain information about the tissue type or organ associated with the cancer signal to guide next steps.

At METSI Care, we are deeply concerned about the rise of the Four Horsemen. These conditions are a major public health problem, and they have a significant impact on the lives of millions of people. We are committed to help our patients prevent and manage diseases.

We offer a variety of services to help our patients prevent and manage chronic diseases. We provide counseling on healthy eating, exercise, and smoking cessation. We also offer screenings for chronic diseases and several programs to help you manage these conditions.It's important to note that we also conduct specific laboratory tests for the study of atherosclerosis. These lab tests include: CRP Cardiac (or hs-CRP), Apo-B Lipoprotein, and Lipoprotein(a). These tests are essential in assessing and understanding the presence and risk of atherosclerosis, enabling us to offer more precise and personalized diagnoses to our patients.

Stay tuned for our upcoming blog post, where we will dive deeper into these health problems and how we can prevent them.

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