The People Who Never Seemed to Age
Chapter 1
A Tale of Two Patients — 1
Meet my patient Mrs. L. R. She’s ninety-eight years young and has never suffered a day of serious illness in her long life. She was referred to me by her primary care physician to assess her heart condition because she had developed swelling in her legs, known as edema. When we first met in the clinic, I noted there was no accompanying family member, so I asked how she got to the medical center. She’d driven herself. I soon learned much more about this exceptionally vibrant, healthy lady who lives alone, has an extensive social network, and enjoys her solitude.
Her remarkable health span isn’t shared by her family members. Her mother died at age fifty-nine; her father at sixty-four. Her two brothers died at ages forty-three and seventy-five. Three years prior to our meeting, her husband had died at age ninety-seven. He had also been quite healthy, with a similar health span profile in contrast to his parents and siblings, who all had chronic diseases and died decades younger. Following her husband’s death, Mrs. L. R. got depressed and dropped thirty pounds. She lost her interest in her hobbies of painting and doing one-thousand-piece jigsaw puzzles. She did continue to play cards and Rummikub every week with a circle of eight women. One of these friends suggested she move from the house she’d lived in for decades to a senior residence apartment. The move led her to artists, new friends, and an extended social network. This all brought her back to her “old” self, fully restoring her passion for her award-winning oil painting, and doing puzzles too. I met a woman brimming with optimism with a sunny disposition and an easy laugh.
The consultation needed to determine why she had some leg edema. Although she had no history of high blood pressure, her heart was thickened on my smartphone echocardiogram and her heart muscle function was well beyond the normal range. Her ejection fraction, the proportion of blood squeezed out of the main pumping chamber with each beat, was abnormally high. I diagnosed hypertrophic cardiomyopathy of the elderly, coincidentally a condition that I had described years before in the New England Journal of Medicine. Her heart had become stiffened and had difficulty relaxing. This accounted for the leg edema, the treating of which was straightforward. The leg edema cleared, and she has remained without symptoms.
Mrs. L. R. exemplifies healthy aging. She is the unusual individual who has escaped all the common age-related diseases, a resilience that defies what most of us expect from the human aging process. Her extreme health span and longevity, as well as her husband’s, do not appear to be related to genetic makeup. Medical scientists don’t understand it, but they would conclude, from all we know about the biology of aging and process of elimination, that it’s stochastic, a random stroke of good fortune.
In marked contrast, let me briefly introduce another patient of mine whom I have followed for over thirty years, who is now also ninety-eight. At age seventy-five, following coronary artery bypass surgery at age sixty-two, Mr. R. P. presented with angina. At the time, I placed two stents in one of his bypass grafts that had developed blockages, which stem from buildup of atherosclerosis that limits blood flow. He later developed rapid atrial fibrillation resistant to medications and underwent two ablation procedures to maintain a normal heart rhythm. Many years subsequently, he had a shoulder replacement and sustained a small heart attack postoperatively. At age ninety-six, he was hospitalized with COVID pneumonia and, despite a prolonged hospitalization, did not develop respiratory failure and fully recovered. Mr. R. P. represents the triumphs of modern medicine. He had severe atherosclerotic cardiovascular disease, but with repeated restoration of blood supply to his heart and aggressive secondary prevention treatment, all was well. He embodies the medical progress we’ve made with age-related diseases. What’s exciting now is that we can accurately forecast heart disease as well as the other major diseases of aging in high-risk individuals many decades earlier and achieve primary prevention, or, at the very least, a marked delay in their appearance. Doctors can’t promise to reverse or halt aging itself, but we can promise the second half of our lives can be much healthier than our forebears’. This is the type of health span extension that we will be seeing far more commonly in the future owing to the phenomenal advances in the five dimensions I highlight throughout this book.