Understanding Risk Factors to Promote Healthy Aging

Posted in GUMC Stories

OCTOBER 18, 2015—Knowing your numbers and family history, as well as exercise, are the keys to aging well, researchers explained at Doctors Speak Out, a luncheon series of conversations with leading Georgetown physicians and scientists on important health issues.

The October 5 event in the Georgetown University Hotel and Conference Center marked the start of the program’s seventh year and broadly covered the topic of healthy aging, unlike most previous Doctors Speak Out events which have focused on more narrow topics, including Alzheimer’s disease, patient safety, mental health and transplant medicine.

Advances in genetic testing have made it easier for doctors to assess a patient’s risk of developing certain cancers, including breast cancer. “If there is a strong or suspicious family history, genetic counseling and testing can be very helpful,” said Claudine Isaacs, MD , professor of medicine and oncology, co-director of the Breast Cancer Program and medical director of the Fisher Center for Hereditary Cancer and Clinical Genomics Research at Georgetown Lombardi Comprehensive Cancer Center. “We’re really understanding genetics more and more.” Additionally, individuals who have had genetic testing in the past may want to consider additional testing.

That improved understanding of genetics is leading to the development of better cancer prevention and treatment strategies and patients who know their family histories can use those strategies to their advantage. Isaacs encouraged attendees to not only learn their family histories and communicate them with their doctors, but also to be persistent with their concerns. “They don’t have that much time with you, those poor primary care doctors,” she said. “So it is important to be an advocate for yourself as well. If you know something, if you find something that bothers you in terms of family history, make sure that that gets addressed.”

“The great news is that most women with breast cancer will survive and do well,” Isaacs said.  “As a result, we are increasingly focusing on identifying which patients can be spared treatments and their attendant side effects as well as developing strategies to minimize the side effects of our treatments.”

Advances in heart disease screening are also making it easier for people to understand their risk, said Allen J. Taylor, MD , chief of cardiology at MedStar Heart and Vascular Institute and professor of medicine at Georgetown University School of Medicine.

“With heart disease, you need to know your numbers – your cholesterol and your blood pressure,” Taylor said. “We actually have new methods such as CT scanning, screening for heart disease, early artery build-ups, that tell people very early on what their risk is – is it above, equal to or below that of their age-related peers? And that’s an important thing because when you have such great preventive strategy, you have to get them to the right people. So I’m excited about these new screening techniques to help everyone understand their heart disease risk better.”

High blood pressure, or hypertension, is the single most important and treatable risk for stroke, cardiovascular disease, disability and death nationally and worldwide. However, patients who focus on their blood pressure readings from their annual physical exams might not know their true blood pressure.

“We know that about a quarter of patients have an artificially higher blood pressure in the doctor’s office – white coat hypertension,” said Christopher Wilcox, MD, PhD , chief of nephrology and hypertension, director of the Hypertension, Kidney and Vascular Research Center and George E. Schreiner Chair of Nephrology at Georgetown University Medical Center. “But even more dangerous, about 20 percent have an artificially low blood pressure, or masked hypertension, in the doctor’s office, so they may have true hypertension.” He encouraged attendees to purchase a blood pressure machine to take their own blood pressure and discuss their findings with a doctor.

Separating Fact from Fiction

Many people self-medicate with over-the-counter drugs, supplements or vitamins to reduce their odds of developing conditions related to aging, even when the effectiveness of such products has not been proven. For example, Taylor cautioned against taking aspirin every day unless it has been recommended by a doctor. “Aspirin is being de-emphasized, particularly for healthy persons without known heart disease, because of the risks of aspirin causing bleeding without much benefit,” he said.

On the other hand, people are frequently skeptical about the benefits of taking cholesterol-lowering statins, which have a strong track record for efficacy with few side effects. “We tend to sometimes latch on to medicines that don’t work as well in place of those that do work well,” Taylor said. “Statins, the standard cholesterol reduction pills, are in fact very, very safe, despite what you may read in online sources. And they’re highly effective so they’re our go-to medicines.”

Wilcox described the presently available antioxidants as ineffective. “Antioxidant vitamins are a sham,” he said. “They don’t work. We’re waiting still for good antioxidants and that’s part of our drug development program. I believe we’ve got a spectacular antioxidant underway.”

The panelists agreed on one thing people can do to improve their likelihood of aging well. “When it’s been evaluated against other forms of prevention, exercise beats them all. It’s better than any drug or any diet,” Wilcox said. “Almost everyone can exercise regularly and it dramatically reduces risk of all cardiovascular disease and lowers blood pressure and is an essential component of weight loss, if you’re going to try that too.”

“If you exercise, your risk of heart disease is half that of someone who does not,” Taylor said. “Exercise and diet is better than any drug.”

Kat Zambon
GUMC Communications