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Optimal Aging: Living to 100!
Barbara J. Steinberg, DDS
Clinical Professor of Surgery
Drexel University College of Medicine
Philadelphia, Pa
The Number One
Killer of Men and Women:
Heart Disease
> 82 million American adults are
estimated to have 1 or more types of
cardiovascular disease (1 in 3 people)
2,200 Americans die of cardiovascular
disease each day an average of 1
death every 39 seconds
Cardiovascular Disease
Risk Factors
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Smoking
Hypertension
Elevated cholesterol
Overweight / obesity
Physical inactivity
Diabetes
Family history
Age
Male Gender
Cardiovascular Disease
Other factors that may affect risk
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Stress
Oral contraceptives
Menopausal hormone therapy
Alcohol
Cardiovascular Disease
Blood Pressure Classification
(Adults 18 and over)
Category
Systolic
Diastolic
Normal
<120
and
<80
Prehypertension
120-139
or
80-89
Stage 1 Hypertension
140-159
or
90-99
Stage 2 Hypertension
>159
or
>99
Cardiovascular Disease
Classification of Cholesterol Levels
Total Cholesterol
Under 200
200-239
240 and above
Desirable
Borderline High
High
LDL Cholesterol
Less than 100
100-129
130-159
160-189
190 and above
Optimal
Near-optimal
Borderline High
High
Very High
*LDL in very-high-risk people with CHD should be < 70
Cardiovascular Disease
Classification of Cholesterol Levels
HDL Cholesterol
Under 40
Over 60
Low
High
*Optimal HDL should be > 50 for women
Triglycerides
Under 150
150-199
200 and above
Optimal
Borderline high
High
Source: NIH: May 2001
Cardiovascular Disease
Risk Factors
Overweight / obesity
• Two-thirds of Americans are overweight or obese
• Body Mass Index (BMI)
• 18.5 – 24.9 normal
• 25 – 29.9 overweight
• 30 or > obese
Cardiovascular Disease
Risk Factors
Overweight / obesity
• Waist measurement ≥ 35
inches for women and
≥ 40 inches for men 
risk of heart disease
Cardiovascular Disease
Risk Factors
Family history
• Father or brother had cardiac event < 55 yrs
• Mother or sister had cardiac event < 65 yrs
Cardiovascular Disease
Emerging Risk Factors
C-reactive protein
(CRP)
• C-reactive protein levels and
risk of cardiovascular
disease:
• > 3 = high risk
• 1 – 3 = average risk
• < 1 = low risk
Symptoms of heart disease that may
experienced
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Chest pain or discomfort
Atypical chest, stomach or abdominal pain
Nausea, vomiting, or dizziness
Extreme fatigue, weakness, and sleeplessness
Shortness of breath
Unexplained anxiety
Palpitations
Cold sweat
Paleness
Severe indigestion
Jaw, neck, or shoulder pain
Cardiovascular Disease
Prevention and Treatment
Lifestyle Changes
Heart Healthy Eating Plan
• Low in saturated fat and cholesterol
and moderate in total fat (20%-35% of calories)
• Limit saturated fat to < 10% calories
(7% if possible) and trans fats to < 1%
• Limit salt and sodium < 2300 mg ~ 1tsp
• 1500 mg
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≥ 51 yrs. of age
African Americans
Hypertension
Diabetes Mellitus
Chronic Kidney disease
Cardiovascular Disease
Heart-Healthy Foods
Fish
– Omega-3 fatty acids
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Herring
Sardines
Salmon
Atlantic or Pacific Mackerel
Trout
Halibut
Anchovies
Pacific Oysters
– Eat at least 8oz./week
Cardiovascular Disease
Role of Supplements
• Consider omega-3 fatty
acids in capsule form (fish
oil)
– 1-2 grams/day
• DHA 400-800 mg
• EPA 600-1200 mg
OBESITY
Associated with:
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Coronary artery disease
Hypertension
Stroke
Type-2 diabetes
Cancer (endometrial, breast, colon)
Sleep apnea
Osteoarthritis
 health care costs
 quality of life
 risk of premature death
Fiber
• Benefits
– Strongest in diabetes and heart disease where its
thought to improve cholesterol levels, blood pressure,
inflammation and blood sugar levels
– May bind to toxins and move them out of body quicker
– High fiber diets can promote weight loss making people
feel full
Dietary Fiber Intake and Mortality in the
NIH-AARP Diet and Health Study
• Prospective cohort study included more than
388,000 adults ages 50-71
– Diet assessed using a food–frequency
questionnaire at baseline (124 food items)
– After 9 yrs. more than 31,000 of the participants
died as per national death records as to who died
and cause of death
– Other risk factors taken into account
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Weight
Education level
Smoking
Health Status
Dietary Fiber Intake and Mortality in the NIHAARP Diet and Health Study
• Prospective cohort study included more than
388,000 adults ages 50-71 (con’t)
Results:
– Dietary fiber intake lowered the risk of death
from cardiovascular, infectious, and respiratory
diseases by 24%-56% in men and by 34%-59%
in women
– Inverse association between dietary fiber
intake and cancer death was observed in men
but not in women
Dietary Fiber Intake and Mortality in the NIHAARP Diet and Health Study
• Prospective cohort study included more than
388,000 adults ages 50-71
Results (con’t)
– Dietary fiber from grains, but not from other
sources, was significantly inversely related to total
and cause specific death in both men and women
Dietary Fiber Intake and Mortality in the
NIH-AARP Diet and Health Study
• Prospective cohort study included more
than 388,000 adults ages 50-71
Conclusion:
- Dietary fiber may reduce the risk of death
from cardiovascular, infectious and respiratory
diseases
- Making fiber-rich food choices more often
may provide significant health benefits
Y. Park, ScD; A.F. Subar, PhD; A. Hollenbeck, PhD, A. Schatzkin, MD
Archives of Internal Medicine
Published Online February 14, 2011
Inflammation
Related to:
• Cardiovascular disease
• Alzheimer’s disease
• Cancers (colorectal, breast, prostate, and others)
• Kidney disease
• Lupus
• Arthritis
• Psoriasis
• Periodontal disease
Inflammation
• C-reactive protein level
– Normal 0-1.0mg/dl
• How to reduce inflammation
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Exercise
Quit smoking
Heart healthy diet
Adequate sleep
Reduce stress
Vitamins
• A good multivitamin (MVI) is the best way
to supplement a diet that may be lacking
– People > 60 should consume a MVI even if they
eat a healthy diet because food is not digested
as efficiently when we age
Vitamins
• Recommended: MVI that provides 100% of the
Recommended Dietary Allowances (RDA) for
essential nutrients established by the US Food
and Nutrition Board of the National Academies /
Institute of Medicine
• Calcium (At least 1200 mg/day recommended for
adults 50 and over ) and vitamin-D supplements
may also be needed
• Some evidence suggests that taking too many
antioxidant supplements (i.e. vitamin C and E)
might actually depress rather than enhance your
immune system
Vitamin B12
• Vital for clear thinking, for nerves, RBC’s, to
help develop genetic material in cells, and
to prevent some forms of anemia.
• Present in almost all animal products
– Milk, meat, fish, poultry, eggs, etc.
Vitamin B12
• As we age, we have a harder time
extracting vitamin B12 from foods. B12 needs
to be broken down and that process is less
efficient as we age.
– Taking a MVI will provide 2.0mcg of B12 (need
2.4 mcg a day)
Vitamin D
• Important for:
– Calcium and phosphorous absorption
– Helps prevent osteoporosis and other metabolic bone
diseases
– Plays a role in preventing cancer (colon, breast,
ovarian, kidney, prostate)
– Immune function
– Brain function
– Heart disease prevention
– Diabetes prevention
– Possible role in multiple sclerosis, lupus, irritable bowel
syndrome and Parkinson’s disease
Vitamin D
• Obtained form 3 sources:
– Sunlight
• Exposure 3 times / week for 10-15 minutes, no
sunscreen
• As you age, your skin’s ability to convert UVB rays into
vitamin D , so it is almost impossible to get enough
vitamin D from sun exposure
• If you live in northern states, from Oct. – Apr., the
angle of the earth prevents UVB rays from making
their way to the ground, so you can’t rely on sunlight
for vitamin D during that time.
• Dark-skinned individuals do not readily absorb the
UVB rays and therefore are at  risk of vitamin D
deficiency.
Vitamin D
• Obtained form 3 sources:
– Dietary
• Fish high in oil content
–Salmon
–Herring
–Mackerel
–Oysters
–Sardines
–Shrimp
• Some cereals, juices, and milk fortified with
vitamin D
• Supplements
Vitamin D
– Vitamin D3 (cholecalciferol)
• Stronger and more active than D2
• 1000 IU / day
• 2000 IU/ day recommended for those at 
risk for Vitamin D deficiency
–Obesity
–Osteoporosis
–Limited sun exposure
–Medications that  nutrient absorption
in the GI tract.
Vitamin D
•Vitamin D deficiency is very common
– 50% of women > 55 deficient
– Test to determine concentration of vitamin D in
the blood
• 25-hydroxy vitamin D (normal range 30 – 74
ng/ml)
People with  levels of vitamin D have a 26%  risk
of death from any cause according to John Hopkins
researchers
Cancer
• Almost in 1 in 2 Americans ~ 41% of the
population will be diagnosed with cancer in
their lifetime
• 2nd most common cause of death in U.S.accounts for 1 of every 4 deaths
- Estimated that ~ 1/3 of the
cancer deaths each year are due to
poor nutrition, physical inactivity
including excessive weight
Cancer
• Lung cancer accounts for more deaths than
any other cancer in both men and women
• 5yr. relative survivor rate for all cancers
diagnosed between 1999-2005 is 68% up
from 50% in 1975-1977
Cancer
Reducing risk:
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Stay away from tobacco
Stay at a healthy weight
Get moving with regular physical activity
Eat healthy with plenty of fruits and vegetables
Limit how much alcohol you drink (if you drink at all)
Protect your skin
Know yourself, your family history, and your risks
Have regular checkups and cancer screening tests
Alzheimer’s Disease (AD)
• Estimated 5.3 million Americans have AD
– 1 in 8 people ≥ 65 yrs.
– More common in women
• Projections: by 2030- 7.7 million people
by 2050- 11-16 million people
Alzheimer’s Disease
10 Warning Signs
• Memory loss that disrupts daily life
• Challenges in planning or solving problems
• Difficulty completing familiar tasks at home, at
work or at leisure
• Confusion with time and place
• Trouble understanding visual images and
spatial relationships
• New problems with words in speaking or
writing
Alzheimer’s Disease
10 Warning Signs (con’t)
• Misplacing things and losing the ability to retrace
steps
• Decreased or poor judgment
• Withdrawal from work or social activities
• Changes in mood and personality
Simple Lifestyle Measures May Help
Maintain Cognition As We Age
• Control blood pressure,
cholesterol, and blood
sugar levels
• Quit smoking (smoking
increases blood pressure)
• Stay physically active (e.g.
dancing, tennis, bicycling,
or any physical activity you
enjoy)
Simple Lifestyle Measures May Help
Maintain Cognition As We Age
• Stay mentally active
– Exercise the mind with mental challenges as you
age (e.g. play chess, bridge, learn a new language,
crosswords, games, reading, puzzles, etc.)
Simple Lifestyle Measures May Help
Maintain Cognition As We Age
• Maintain a strong social network
– Support system of family and friends
– Stay socially connected and interact with people
Simple Lifestyle Measures May Help
Maintain Cognition As We Age
• Manage your mood
– Anxiety, worry, anger, and depression have been
linked with higher rates of cognitive impairment
– May require professional help
Simple Lifestyle Measures May Help
Maintain Cognition As We Age
• Avoid head injury
– Take steps to prevent falls
• Get enough sleep
– Short term memory improves when you get plenty
of sleep (at least 7 hours a night)
• Heart healthy diet
– Whole grains and fatty fish are linked to production
of high density lipoproteins which are associated
with the preservation of memory