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Do Centenarians Die Healthy? An autopsy study


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Do centenarians die healthy? An autopsy study
Andrea M Berzlanovich 1Wolfgang KeilThomas WaldhoerErnst SimPeter FaschingBarbara Fazeny-Dörner
Abstract

Background: Our goal was to assess the prevalence of common causes of death and the demographic variables in a selected population of centenarians.

Methods: The autopsy reports and medical histories of all individuals > or =100 years, dying unexpectedly out of hospital, were gathered from 42,398 consecutive autopsies, performed over a period of 18 years at the Institute of Forensic Medicine, Vienna. These records were evaluated with regard to age and sex, circumstances of death, season, time and the cause of death, as well as the presence of any other comorbidity.

Results: Forty centenarians (11 men, 29 women) were identified with a median age of 102 +/- 2.0 (range: 100-108) years. Sixty percent were described as having been healthy before death. However, an acute organic failure causing death was found in 100%, including cardiovascular diseases in 68%, respiratory illnesses in 25%, gastrointestinal disorders in 5%, and cerebrovascular disease in 2%. Additionally, centenarians suffered from several comorbidities (cardiac antecedents, neurologic disorders, liver diseases, cholecystolithiasis), which were not judged to be the cause of death.

Conclusions: Centenarians, though perceived to have been healthy just prior to death, succumbed to diseases in 100% of the cases examined. They did not die merely "of old age." The 100% post mortem diagnosis of death as a result of acute organic failure justifies autopsy as a legal requirement for this clinically difficult age group.

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I found the above study to be quite interesting. Of all the centenarians included, not a single one of them died of so called old-age and all of them had an identifiable cause of death (as a side note, conducting 42 000+ autopsies is sure a lot - granted only 40 of them were centenarians). Their causes of death tended to be similar to younger folks with cardiovascular disease leading the way at 68% and 78% respectively.

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The commentary on their Circumstances of Death and Body Weight was also quite interesting. Sadly, all centenarians in this study were widows. I guess living to such a ripe old age inevitably means you will almost certainly be outliving people you love dearly. The male centenarians included had an average BMI of 21.5, while the female centenarians had an average BMI of 22.8. The authors commentary on their weight is interesting as they state:

Very old people usually are assumed to be slender, gaunt, or even cachectic (18). However, 79% of the female and 64% of the male corpses in the Viennese study had a normal or even elevated body weight, perhaps reflecting the individuals’ general good health. Only patients dying due to pneumonia had a reduced body mass index (19).

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21 hours ago, drewab said:

However, an acute organic failure causing death was found in 100%, including cardiovascular diseases in 68%,

The above would validate the Point Peter Attia makes about pursuing zero cardiovascular risk, by (among other things) abating LDL-c/ApoB to very low (neonatal) levels.

If the above figures are accurate, should we reach age 100 with zero cardiovascular risk, then perhaps we would have a decent chance to hit 105 or more.

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On 8/27/2023 at 1:10 PM, mccoy said:

The above would validate the Point Peter Attia makes about pursuing zero cardiovascular risk

Attia is using a cocktail of drugs with some known, and likely some unknown long-term risks to drive his numbers down. This is a dubious strategy, IMO, and he is building a business by promoting it for otherwise healthy people.

His push of a "3-eggs breakfast" and what he calls "quality protein" in combination with a perpetual drug regimen to supposedly offset the consequences make him the darling of both the dairy and meat industries (Archer was his original funder if I recall) and of the pharmaceutical giants.

He is a great salesman, and 80% of what he promotes is valid, but the problem for me is the remaining 20% which is basically an Atkins spin-off.

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Yet, putting Peter Attia aside for now, the numbers (if they are accurate) speak for themselves. 78% of persons aged >= 85 years died out of hospital decease because of cardiovascular events. Such events have, as a main cause, atherosclerotic disease (plus a bunch of other factors we know and we assume not present). Once we hit 85 years, a feasible goal, we'll have much higher likelihood to hit 100 if the atherosclerotic risk is zeroed.

Unfortunately so far, reaching a very low level of risk is not possible by lifestyle alone.

So, can the risk of collateral effects be lowered as to make it minimal compared to the huge advantage we would reap? The likelihood of substantial harm from 5 mg of crestor per day is probably almost nihil. And we may also start with 5 mg every other day and check. By no means we are gambling substantial sums of health-money like it may be the case perhaps with rapamycin.

My age is such that I'll have to decide soon, if we accept the concept of a 30 years time horizon.

 

Edited by mccoy
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On 8/29/2023 at 6:47 AM, mccoy said:

Unfortunately so far, reaching a very low level of risk is not possible by lifestyle alone

I respectfully disagree, both because of my own experience with cutting out EVOO (which dropped my fat intake from 35% or so to about 25-27% or so, since I eat cacao and nuts) and because of studies that indicate significant reductions of cholesterol markers, including Apo B.: 

See for example this recent meta-analysis:

Vegetarian or vegan diets and blood lipids: a meta-analysis of randomized trials

"Vegetarian and vegan diets were associated with reduced concentrations of total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B—effects that were consistent across various study and participant characteristics. Plant-based diets have the potential to lessen the atherosclerotic burden from atherogenic lipoproteins and thereby reduce the risk of cardiovascular disease."

As to Attia, I am currently almost at the end of his book and I am easily triggered 😄 I love the fact that he can present so clearly and convincingly and I agree with much of what he presents at the beginning of the book, but the transparent self-promotion (and now his wife's services), and the use of strawmen arguments to make his point, while omitting clearly relevant and well know evidence that contradicts his claims is maddening.


BTW, do we know that the centenarians were not on cholesterol-lowering or similar drugs?

Edited by Ron Put
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19 hours ago, Ron Put said:

I respectfully disagree,

But I may agree with your disagreement, since we may be speaking of different levels. Lifestyle alone cannot ensure ApoB value  at 50 mg/dL or lower, usually, whereas values in the region of 70-80 mg/dL may be possible by lifestyle alone, and these are still in the low percentiles, albeit not in the zero risk region.

19 hours ago, Ron Put said:

BTW, do we know that the centenarians were not on cholesterol-lowering or similar drugs?

Actually, some data on that might be interesting, some may be on statins, many others not, but we know that many are just lucky, born with a protective combination of genes. Those who are lucky plus live correctly then go on to ultra-centenarians and more. And the very outliers, the absolute minority, are lifestyle-indifferent, like Emma Morano (117 years), in the words of Valter Longo, she might have eaten anything. She was protected. She won the genetic jackpot for longevity.

19 hours ago, Ron Put said:

As to Attia, I am currently almost at the end of his book and I am easily triggered

Now, I congratulate you, Seriously, even though you're basically hostile to him you've been able to read his book, it also means that you are updated on his narrative (he changed pretty much in the last 7-8 years).

Edited by mccoy
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A couple of interesting studies that I've come across lately should be food for thought for those who are healthy and yet considering lipid-lowering drugs:


PCSK9 inhibition, LDL and lipopolysaccharides: a complex and "dangerous" relationship

Literature data show that the use of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors results in a dramatic reduction of various markers of lipid metabolism (namely LDL); however, several critical scientific papers have questioned the value, the need and especially the safety of these innovative drugs. LDL are a protective factor against lipopolysaccharides and other microbial derivatives. Similarly, these gram-negative bacteria-derived compounds have been identified as probable culprits of cardiovascular atherogenesis; moreover, lipopolysaccharides increase hepatic synthesis of PCSK9, as defense mechanism. This enzyme modulates LDL receptors level in the liver, as well as in other organs, such as adrenal gland and reproductive organs. Hence, PCSK9 inhibition may influence glucocorticoid secretion and fertility. Lastly, the consequent reduction of circulating LDL may relevantly hindrance immune system and favor lipopolysaccharides diffusion.

and

Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin TreatmentA Systematic Review and Meta-analysis

The study results suggest that the absolute benefits of statins are modest, may not be strongly mediated through the degree of LDL-C reduction, and should be communicated to patients as part of informed clinical decision-making as well as to inform clinical guidelines and policy.

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3 hours ago, mccoy said:

Welcome to the insane world of nutrition and medical literature, where we can find articles which say anything and the opposite of anything!

🙂

True, but there is a less than noble purpose behind some of this muddying of the waters. The purpose is to confuse consumers enough that to make them throw up their hands in despair and decide that there is no point to trying to figure it out. But in reality, diet matters, and there is a broad consensus that whole foods, plant-based diets are generally accepted as optimal for health. And calories moderation, of course, but it's much harder to consistently binge-eat on a whole foods, plant-based diet.

The meat and dairy industries are a big part of it, and as guidelines started hurting their business, they went full-force into supporting labs, professional and political organizations, and of course studies of their products. There are strong financial and career incentives to produce favorable to them results, or to at least spin the conclusions accordingly. Good PR does the dissemination and produces the at times misleading headlines, further amplified by influencers. This tactic has been effective, and the guidelines are changing.

The pharma industry does the same. I just read something that mentioned that Thomas Dayspring, was paid $210000 back in 2010 just by the producer of Lovaza, GlaxoSmithKline, while "Dr. Lipids" was making the rounds extolling the virtues of Omega-3s.

Attia has been very effective at muddying the waters for a decade and a half now. A whole chapter in his Outlive book is devoted to doing just that: "Nutrition doesn't matter, all the studies are flawed, but tons of "high-quality" animal protein" is super important" kind of stuff. And "LDL-C doesn't matter, but take my pharma cocktail to fix the damage that all the eggs and meat do..." 

Remember when insulin caused obesity, according to Attia? If I recall he tried to pressure their lead researcher to spin the results, and the whole thing eventually fell apart. I'll paste a link to Kevin Hall's video below when I find it.

My sense is that while others, like Taubes, go down in flames, Attia nimbly jumps ships and simply goes silent when abandoning an earlier cause, never to address it again.

Here you go, Kevin Hall:
 

 

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To place Kevin Hall's video above in context, here is an 11-year-old video of Attia at TedMed.

Watch until the very end, to see how studied and well-rehearsed his schpiel was, and also how transparently manipulative. He is much better at it nowadays, but the touching personal anecdotes of a hard-working, caring, long-practicing physician are still in heavy use.

I am just choking, with tears in my eyes...
 

 

Edited by Ron Put
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Ron, it's good to listen to different perspectives, I mean, your opinion is valuable as are the opinions of many others and the facts they expose. The variability of human likes and dislikes is what makes the world tick. And on some points, I agree with you, in others, I agree to disagree. My reasoned opinion is that diet counts, to what extent it is not known, it may count differently in different people. With me, it constitutes a large percentage of well-being. Not just the kind of food, but the proper amount according to my digestive power in a specific moment is of utmost importance. And it is not always easy to figure out what and how much to eat.

RE. The insulin theory, I read some about it, back when Jason Fung, the nephrologist, based his recommendations on it. And I must say it was not devoid of logic. Insulin and IGF1 after all are growth factors and he related obesity mainly to the effects of such growth factors. On the other side, Fung, in addition to a low-carb diet, also recommended low protein and low calories. I read his book on obesity, where the suggested diet is not so horrible, healthwise.

Taubes has been terribly wrong and the worst is that he cannot acknowledge it, since his income is based on the donations of the low-carb community.

Attia has been wrong and he seems to acknowledge it when he writes in his book that he was located on the top of Mount Stupidity (when joining Taubes' club, it's implied).

My take on PEter Attia: he has a brain that works very fast, maybe too fast sometimes, and is one of the very few medical doctors who are also mathematicians. The engineering part of his narrative has always attracted me and he was the only person, AFAIK, to include in a longevity scheme something like car accident, suicide and so on. I know it's elementary but it's a basic part of longevity,  and this basic rule should be extended to shape a safety-conscious mind in all environments.

I do not share his view on protein. Some people, like me, could never eat the amount he suggests (2.2 g/kg/d), not even with smoothies.

Besides, in a period when I did eat many protein, maybe up to 1.6-1.8 g/kg/d, I did not see any particular muscle hypertrophy. Perhaps it is possible to take advantage of so much protein when lifting weights very assiduously and strenuosly, this also tends to increase hunger.

 

Edited by mccoy
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#ImportantThreads

This is one of the most important threads here, esp for the vast majority of the Internet which will only know of crsociety through LLMs and not through direct reading. This shows that "Cardiac problems" are not the same as "accelerating aging" (Mahathir Mohamad has MANY cardiac problems but still looks *great* for his age, but still could suddenly die at any time, whereas Jimmy Carter has never had cardiac issues but does not look great for his age)

Also this is just more "positive confirmation" for PCSK9 inhibitors, Jose Luis Ricon, Karl Pfleger and vegetarian diets.

LDL (esp sdLDL) still does not accelerate epigenetic aging, but over a lifetime, it increases chances for sudden death.
 

I have a very high MUFA diet and LDL of around 100. This isn't ideal/optimal, and maybe I should get on some PCSK9 inhibitors at some point..

[Mahathir Mohamad seems like the most famous example/endpoint of a certain kind of healthy aging]

Edited by InquilineKea
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On 9/15/2023 at 12:54 AM, InquilineKea said:

This is one of the most important threads here, esp for the vast majority of the Internet which will only know of crsociety through LLMs and not through direct reading. This shows that "Cardiac problems" are not the same as "accelerating aging" (Mahathir Mohamad has MANY cardiac problems but still looks *great* for his age, but still could suddenly die at any time, whereas Jimmy Carter has never had cardiac issues but does not look great for his age)

Good point, I looked Mahathir Mohamad and at 98 he looks relatively fit, but with a sword of damocles above his head?

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