The following article comes from the U.S. News ebook, How to Live to 100, which is now available for purchase.
Heart disease, cancer, chronic respiratory disease, stroke, and other chronic illnesses are responsible for about 70 percent of American deaths each year. And they all loom larger as we age.
But there's a lot you can do (or in the case of smoking, not do) to steer your fate away from these killers, or dull their impact if they arise. Exercise regularly, fill your plate with fruits and veggies, get enough sleep, say no to cigarettes—essentially everything your mother told you to do.
"People always want a quick fix in our culture," says Amy Locke, a family medicine physician at the University of Michigan Hospitals and Health Centers. No such luck. If you want to avoid an early exit, it's time to replay those instructions from Mom.
Change your ways
Nothing kills more Americans each year than heart disease, which occurs when fatty substances clog the vessels to your heart. The best preventive: a healthy lifestyle.
Abiding by six or more of the American Heart Association's "cardiovascular health metrics"—not smoking, being physically active, maintaining a healthy diet and weight, as well as normal levels of blood pressure, blood sugar, and total cholesterol—seems to make people about 75 percent less likely to die of heart disease than by adhering to only one or none, suggests a recent study in the Journal of the American Medical Association. In fact, people who checked off at least six of these boxes were about half as likely to die from anything at all over the median follow-up period of 14.5 years as those who did one or none.
If a lifestyle overhaul seems overwhelming, remember that adopting even a few good habits is better than doing nothing. "It's about taking it one step at a time," says Locke.
And you can take that literally. Just 30 minutes of moderate-intensity aerobic activity like brisk walking five days a week can reduce your risk of premature death from leading causes like heart disease and cancer, says the Centers for Disease Control and Prevention.
A near-surefire way to forestall your trip to the grave is to stop smoking. Lighting up not only increases your risk of heart disease, but also significantly boosts your odds of dying from lung cancer, the No. 1 cause of cancer death in the United States. A 2008 study published in the Archives of Internal Medicine found that never-smoking men lived an average of 10 years longer than those with a pack-a-day habit. But quitting at any age still may add years to your life. People who stop smoking at age 35 gain about seven extra years, while those who quit at age 65 can tack on an extra one to four, research suggests.
While you're at it, ease up on the bottle. Excessive alcohol intake—any more than one drink a day for women and two a day for men—over time can contribute to liver cancer and has been associated with an increased risk of breast cancer, the second leading cause of cancer death among women. Buckling up and seeking help for depression can also be life-savers. Among men, accidents and suicide are the third and seventh leading causes of death, respectively.
Statistically speaking, simply being American means you've got a good shot of dying from a chronic illness. But you aren't a statistic—you're an individual. How do you know which diseases might knock at your door but pass by your neighbor's?
"All diseases have genetic and environmental components," says Locke. "So you can do what you can to modify the environmental risks and you can be knowledgeable of your personal risks."
Knowing your personal risks means tracking your family history and being aware of how factors like gender, age, race, and ethnicity can affect both your disease vulnerability and the quality of your care. White women, for example, are more likely than black women to be diagnosed with breast cancer, but black women are more likely to die from it.
If you're in a high-risk pool, consider talking to your doctor about genetic testing, which can help guide treatment decisions. (Women who are carriers of a genetic mutation associated with a more aggressive type of breast cancer, for example, might choose to get a preventive double mastectomy in an effort to cut their risk by as much as 90 percent.) But the decision to undergo testing should not be made lightly, or without the guidance of a genetic counselor. "You want people to know their risks, but you don't want them to feel like they have no control over the situation," says Locke.
Other steps, such as choosing not to drink if your relatives struggle with alcoholism or being diligent about sunscreen if melanoma runs in your family, can help tailor prevention to your individual risk profile.
Get screened and vaccined
According to a 2010 paper in the American Journal of Preventive Medicine, our lackadaisical attitude toward clinical preventive services is killing us before our time.
Using mathematical models, the authors predicted that optimal use of nine clinical interventions including colonoscopies, screening and treatment for high blood pressure, and the flu vaccine could prevent up to 100,000 deaths per year in people under 80 years old, and up to 40,000 deaths per year in people under 65. Yet only about a quarter of adults ages 50 to 65 are up to date on recommended immunizations and cancer screening tests, the CDC reports.
What's more, a single pneumococcal vaccine after age 65 and a yearly prick to fight the flu—which kills about 24,000 people annually—can drastically lower the chances of dying from these preventable diseases. The CDC also recommends the over-60 set get a shot against shingles, tetanus, diptheria, and pertussis, conditions that are both more common and more severe in older adults. It may sound like a pain, but with the Tdap vaccine, you can knock out those last three birds with one stone.
Because screening recommendations seem to change as often as the seasons, it's no wonder Americans' use of them is inconsistent. But the controversies—like the fracas caused in 2009 by the United States Preventive Services Task Force, when it shifted the recommended age to begin breast cancer screenings from 40 to 50—tend to center around what ages you should begin and end regular screenings, and how often you should be tested in between. Most experts agree that mammograms and colonoscopies (for both sexes) are important between ages 50 and 75, and that women ages 21 to 65 should get pap smears to detect signs of cervical cancer. Regular screenings for prostate cancer using the prostate-specific antigen (PSA) test, on the other hand, do more harm than good for most men regardless of age, according to the USPSTF’s recently revised recommendations. But like all screenings, the choice to undergo testing should be made with your doctor, keeping your family history, lifestyle, and personal values in mind.
While prevention and early detection are your first line of defense against chronic diseases, appropriate and timely treatment—and adherence to that treatment plan—are just as critical. Nearly 125,000 people die each year because they don't take their medicine as directed, according to the Surgeon General's medication adherence campaign, "Script Your Future."
It's also crucial to recognize the warning signs of top killers. Stroke, the fourth leading cause of death, for example, kills 15 percent of its victims within 30 days. But it doesn't have to. A recent study found that only 51 percent of adult stroke victims had arrived at the hospital via ambulance, a statistic that unfortunately hasn't budged since the mid-1990s. This suggests that many people still don't understand the severity of stroke symptoms and may hesitate before asking a friend or family member for a ride to the ER instead of dialing 911 right away. If you notice numbness in your limbs or face, suddenly have difficulty speaking and seeing, feel dizzy, and/or have a sudden severe headache, call an ambulance immediately. With every minute that passes, so too do your chances of escaping alive and without irreversible brain damage.
To ensure you get the best care possible, find a provider you trust, shamelessly seek out second opinions, and bring an audio recorder to doctors' appointments where the information, in retrospect, can be hazy, advises Nancy Keating, associate professor of medicine and of healthcare policy at Harvard Medical School.
Finally, she urges everyone—even the healthiest—to imagine a future with chronic disease. "What are your goals? What do you value? What do you want out of life?" says Keating. "We don't talk about these things until it's too late."
Updated on 6/8/2012: This story has been updated to reflect the most current prostate cancer screening recommendations. It has also been corrected to convey the most accurate physical activity recommendations: 30 minutes of moderate-intensity aerobic activity five days a week.