The Lucky Years: How to Thrive in the Brave New World of Health (33 page)

In his recent book
Touch: The Science of Hand, Heart, and Mind
, the Johns Hopkins University neuroscientist David Linden summarizes the power of touch perfectly when he writes: “From consumer choice to sexual intercourse, from tool use to chronic pain to the process of healing, the genes, cells, and neural circuits involved in the sense of touch have been crucial to creating our unique human experience.”
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The more we learn about touch, the more we must acknowledge that it’s a primary color in our life from womb to death, bringing healthy hues to us from a developmental, behavioral, cognitive, and emotional perspective. And I have no doubt that future technologies and therapies will leverage this great sense to treat a variety of ailments, from those that cause a great deal of pain to the nuisances of an itch and the ravages of our next topic: inflammation.

When a retired football player gets diagnosed with Alzheimer’s disease, he can point the finger at one likely suspect: inflammation. The same is true of the person with major depression, heart disease, and raging arthritis. We’ve known for some time now that the cornerstone of most chronic conditions, from diabetes and obesity to cancer and dementia, is inflammation—a topic I’ve addressed already. Controlling chronic inflammation can go a long way toward helping one to stave off illness and disease and to preserve metabolic health in the Lucky Years. So how do you do that? I have two big recommendations that I’ve been hawking for years, neither of which will be for everyone. But it’s worth knowing about them. Although I’ve written extensively about these “prescriptions” in the past, they bear repeating with the latest science.

Aspirin, or acetylsalicylic acid, was developed more than a century ago by the German chemist Felix Hoffmann. It has long proved its value as an analgesic, and now it’s earned a label as a potent anti-inflammatory
and anticancer drug as well. Two millennia before Hoffmann isolated the compound in a lab, Hippocrates extracted its active ingredient from the bark and leaves of the willow tree to help alleviate pain and fevers.

In 2009, the United States Preventive Services Task Force spoke strongly on the topic of aspirin when it urged men ages forty-five to seventy-nine, and women ages fifty-five to seventy-nine, to take a low-dose aspirin pill daily. The only exceptions to this “rule” would be for those who are already at higher risk for gastrointestinal bleeding or who have certain other health issues. This recommendation was prompted by many high-quality research studies that showed aspirin can substantially reduce the risk of cardiovascular disease, the country’s leading killer. Its heart-friendly powers likely entail a variety of mechanisms, including keeping blood clots from forming and dampening inflammation.

Newer reports about aspirin’s anticancer qualities have been equally as inspiring. In 2011, British researchers analyzed data from eight long-term studies involving some 25,000 patients and calculated that a small, 75-milligram dose taken daily for at least five years reduced the risk of dying from common cancers by 21 percent.
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In 2012,
The Lancet
published two more papers in favor of a daily baby aspirin. The first, reviewing five long-term studies and more than 17,000 patients, found that this ancient drug lowered the risk of getting adenocarcinomas—common malignant cancers that develop in the lungs, colon, and prostate—by an average of 46 percent.
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In the second study, researchers led by a group at Oxford analyzed fifty-one different studies comparing patients who took aspirin with those who didn’t.
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The risk of dying from cancer was reduced by 37 percent among those taking aspirin for at least five years. In a smaller section of the study group, three years of daily aspirin use lowered the risk of developing cancer by almost 25 percent when compared with the aspirin-free control group. And in 2015, Harvard researchers calculated a 20 percent lower risk of cancers of the gastrointestinal tract, especially in the colon and rectum, among people taking aspirin.
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For their study, the researchers collected data on 82,600 women enrolled in the Nurses’
Health Study in 1980 and 47,650 men enrolled in the Health Professionals Follow-up Study in 1986. The data included aspirin use, risk factors for cancer, and diagnoses of cancer.

After up to thirty-two years of follow-up, about 20,400 women and 7,570 men developed cancer. Prostate cancer was excluded among the men. The people who took a regular, 325-milligram dose of aspirin at least twice a week enjoyed a lower risk of cancer overall than people who did not take aspirin regularly. This reduced risk was largely due to fewer cases of gastrointestinal cancers, including esophageal cancer, colon cancer, and rectal cancer. Aspirin’s anticancer benefits appeared to be related to how much one took: more aspirin, less risk. Amounts in this group of people ranged from less than one aspirin a week to fifteen or more. To gain the most benefit from aspirin meant taking it for at least sixteen years, and the benefit vanished within four years of stopping it.

For some men over the age of forty-five and women over fifty-five, the risks of taking aspirin outweigh any benefits, so you should talk with your doctors before taking a daily dose. My hope is that in the near future we’ll develop a new generation of aspirin that eliminates its negative side effects so everyone can benefit from this wonder drug.

Statins have a negative image in alternative medicine circles that is hard to shake. Statins are compounds that inhibit a liver enzyme that plays a central role in the production of cholesterol. For a long time, we thought the purpose of statins was solely to lower heart disease risk, by virtue of their impact on cholesterol production. But the story doesn’t end there. It turns out that they have a profound effect on the entire body, because they help control systemic inflammation—the biological process that can go into overdrive and trigger all kinds of dysfunction and illnesses if left unchecked. Studies in the past decade show that statins can reduce the risk of first-time heart attacks, strokes, and even death from heart disease by about 25 percent to 35 percent (and in many of these people, high cholesterol is not a problem). Studies have
also shown that statins can reduce the chances of recurrent strokes or heart attacks by about 40 percent.

In 2012, the
New England Journal of Medicine
published a study involving 300,000 people that indicated a dramatically lowered risk of death from cancer among those who took statins.
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Such results, among others, encouraged the American College of Cardiology and the American Heart Association to publish new guidelines in 2013, recommending that doctors prescribe statins to patients even if they are at low risk of having a heart attack or stroke. The new guidelines also suggest that doctors
not
put people on statins based on cholesterol levels alone.

The updated guidelines startled and confused doctors, including cardiologists who’d been trained for years to use statins to reduce the risk of cardiovascular events based on cholesterol values alone. It also didn’t help that the new online calculator meant to help doctors determine a patient’s suitability for cholesterol treatment was called out as being seriously flawed—doubling the estimated risk of heart attack or stroke for the average patient. Not only is the calculator based on outdated and obsolete data, but it—like many other calculators used in medicine—is based on a mathematical model that assumes that risk rises in a straight line. As levels of blood pressure rise, for example, the chances of a heart attack or stroke rise in concert. In reality, though, that line is far from straight. But this calculator is still in use by doctors until a better one emerges. Which is why the conversation about risk factors and the decision to take or not take statins is all the more important to have with your doctors—no matter what any calculator says. Conversation will trump calculation any day.

But the real issue here isn’t so much the power of statins on any single pathway in the body that does or does not lead to vascular disease. It’s the power they have on the body as a complex system. And to grasp this power, consider their impact on a disease as complex as cancer:

• In the 2012 study I just mentioned, Danish researchers examined whether statin use, started before a cancer diagnosis, was
associated with reduced cancer-related death. They assessed death rates among patients from the entire Danish population who had received a diagnosis of cancer between 1995 and 2007, with follow-up until December 31, 2009. Of patients forty years of age or older, 18,721 had used statins regularly before the cancer diagnosis and 277,204 had never used statins. The results? Statin users had a 15 percent lower risk of dying from any cause or from cancer. The reduced cancer-related death among statin users was observed for each of thirteen cancer types.

• A 2015 study looking at roughly 14,000 British lung cancer patients diagnosed between 1998 and 2009 found that those who took statins for a year before getting diagnosed with lung cancer had a 12 percent lower risk of dying from that cancer.
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• Another 2015 study examining data from the United Kingdom’s Clinical Practice Research Datalink found that statin use was associated with about a 50 percent decreased risk for liver cancer, and this was true whether or not patients had risk factors such as liver disease or diabetes.
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• Statin use in men with prostate cancer has been shown to improve their prognosis and slow down the progression of the disease, especially among those who are also taking medication to reduce their levels of male hormones that stimulate their type of cancer.
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And this likely is related to cholesterol. The body produces male hormones from cholesterol. So by reducing cholesterol levels, statins might cause a reduction in available hormones by inadvertently robbing the body of a key building block for those hormones. What’s more, statins might interfere with the process through which prostate tumor cells absorb male hormones. Laboratory tests have shown that statins tend to crowd out hormones, beating them in line to be absorbed by prostate cancer cells.

• A 2014 UK study found that statins may boost colorectal cancer survival. In the largest project to date studying statin use by patients with colorectal cancer, the study combed through the records of more than 7,600 people who’d recently been diagnosed with colorectal cancer.
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Some people’s cancer had spread to nearby lymph nodes. The researchers had, on average, five years’ worth of patient history, including prescription records and death records. From 1998 to 2009, the study period, nearly 1,650 patients died of colorectal cancer. For those who took statin drugs for more than a year, their risk of dying from their colon cancer shrank 36 percent. People who used statins for less than one year reduced their risk by 21 percent. Overall, the study concluded that statin use was associated with a 29 percent decrease in the odds of dying from cancer. The study also documented a 25 percent lower risk of death
from any cause
among those who took statins.

• In a 2013 nationwide Finnish study, statin use was associated with a 66 percent reduction in the risk of dying from breast cancer.
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The researchers looked at statin use and breast cancer mortality among the 31,114 women with breast cancer who were diagnosed in Finland between 1995 and 2003. During follow-up, 6,011 of the women died, 3,169 due to breast cancer. The death rate among statin users was 7.5 percent while among non–statin users it was 21 percent.

I will also add that in 2015, a new report published in the
Journal of the American Medical Association
confirmed that the latest guidelines are actually more accurate and efficient than ever before, despite the initial reactions among doctors who were used to looking at just cholesterol levels.
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Approximately 10 million US adults are newly eligible for statin therapy under the new guidelines, and it’s estimated that between 41,000 and 63,000 cardiovascular events—heart attacks, strokes, or deaths from cardiovascular disease—could be prevented over a
ten-year period. The
JAMA
report points out that the 2013 guidelines accomplish three important tasks: they broaden prevention efforts to encompass all forms of heart disease; they identify adults at high risk for cardiovascular trouble who could benefit from statins; and they distinguish low-risk patients who do not need to take the drugs.

Statins do have their opponents. You’ll find articles and studies linking statin use with
increased
risk of cancer and death. Some implicate them in upping the risk for dementia and type 2 diabetes. But therein lies the challenge: identifying the relevant facts and details, and weighing risks and benefits smartly. In the case of the widely publicized study that showed a relationship between statin use and the development of type 2 diabetes, for example, there was no data regarding weight, ethnicity, and family history—all important risk factors for the development of diabetes.

Keep in mind that, with regard to many of these studies that show a drop in the risk of an illness or death, there are any number of other differences between people who take statins and those who don’t that might explain the outcome, rather than statin use itself. None of these studies—even the ones that condemn statins—can prove a cause-and-effect link. They can speak only to an association. And that’s why they should be considered on a case-by-case basis in the context of the individual, as with everything else in medicine.

Unfortunately, statins are often seen as the prime example of all that is wrong with Big Pharma. They are criticized as overpriced, overmarketed, and overprescribed, while their risks are underplayed. But a ninety-day supply of a statin at Walmart, without health insurance, costs only $10! And, most of all, we cannot ignore the data showing their power. Are statins for everyone? Of course not. But they should be in the conversation.