Reduce your health risk by 78%

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Lifetime Exposures

If you’re a smoker or former smoker, the summary of smoking’s effect on your health and estimated long term risk of lung cancer, emphysema  and cardiovascular disease is described in what are called “pack years.”  To calculate pack years, you multiply the number of cigarettes smoked per day by the number of years smoked.  So, smoking 20 cigarettes a day (which is a standard pack size) for 3 years is a 3 pack year smoking history, and smoking 5 cigarettes a day for 12 years is also a 3 pack year smoking history.  It’s not perfect, but it does seem that the biggest factor to consider is the total lifetime exposure to cigarettes.

5 weeks ago in episode 153, we talked about your exposure to PM 2.5 air pollution particles.  It’s important, because your risk of all kinds of chronic diseases, especially the family of cardiovascular diseases, goes up with increased PM 2.5 pollution exposure.  And a part of why chronic diseases become more common the older we get and even more so, why our immune system doesn’t function as well as we get older, can be because of our lifetime exposure to PM 2.5 pollution particles.  The number of times you’re exposed to PM 2.5 pollution and the duration and intensity of those exposures all play into the long term consequences on your health.  Every exposure matters, because it all contributes to your lifetime exposure.

Lifetime exposure to radiation is also tracked and matters to our long term health.  Lifetime exposure to estrogen is also often considered in studies.  I think these things make a difference and that making sure you never smoke one more cigarette matters, because it adds to your lifetime exposure.  Doing everything in your power to decrease your exposure to poor quality air even on a single day matters.  Minding your radiation exposure has an impact on your long term health.  Because it all contributes to your lifetime exposure.  But, for whatever reason, I haven’t really thought about lifetime exposure to other longevity metrics in the same way until just recently.  So I hope this is helpful to you and your mindset, too.  Let’s make sure you get to your 80s and beyond in good health, shall we?

Risk Calculator

So, there’s this thing called the atherosclerotic cardiovascular disease calculator.  The American College of Cardiology and the American Heart Association both recommend that clinicians use the calculator to estimate the 10 year risk of stroke and heart attack for patients ages 40-79.  You can find the calculator all over the place online and plug in your numbers if you know them.  It asks for your age, cholesterol numbers, blood pressure numbers and whether you have diabetes.  The problem is that the biggest driver of 10 year risk is age.  So when you’re in your 20s there’s almost no blood pressure or cholesterol level high enough to predict a heart attack or stroke within the next 10 years, and when you’re 80, there’s almost no blood pressure or cholesterol level low enough to not predict a heart attack or stroke.

But when you care about lifetime exposure, rather than just 10 year risk, everything changes.  I for sure don’t want you to have a heart attack or stroke or other life threatening or debilitating illness in the next 10 years, but I also don’t want you to have one in 30 years, either.  It’s all about knowing the game you’re playing.  Are you playing the 10 year game, or the 40 year game?  Or 50 year game, I like that even better.

The biggest predictor of heart attack or stroke is lifetime exposure to high blood pressure or lifetime exposure to high apoB lipoprotein particles, which are attached to some LDL cholesterol particles.  I have a lot of thoughts about cholesterol management and treatment, but for today, let’s just say that a high lifetime exposure to apoB particles is a predictable driver of cardiovascular disease.  I think everyone knows that having high blood pressure or an unfavorable cholesterol profile (whatever that may mean, which is radically different to different experts) is not so good.  

We’re not playing the today game or the 10 year game

We all know it’s not great, but there isn’t a whole lot of urgency to take corrective action, because the risk still seems low.  Because it is.  If our blood pressure is 125/85, it’s not that big of a deal, it’s not crazy high.  Which is true, it’s not.  But it doesn’t mean that it doesn’t matter.  Because we’re not playing the today game or the 10 year game, we’re playing the 50 year game, and in that case, it matters a lot.  I’ll put a link in the show notes to a very well written article by Dr. Peter Attia that lays out all of these facts in deep detail.  If you’re feeling it, jump neck deep into mendelian randomizations and get down with your bad self.  It’s a good one.  Dr. Attia explains how from ages 70-74, death rates per 10,000 people from cardiovascular disease and cancer are 58 and 73, respectively.  At the ages of 95-99, death rates are 1,013 and 182, respectively.  That’s crazy.  The longer you live, you become 10 x more likely to die of cardiovascular disease than cancer.  So doing something about it is a must for forward-thinking people.

Lifetime Exposure and Cardiovascular Disease

A big mendelian randomization study showed, with all the detailed charts and graphs and bells and whistles that you can find if you click on the link to the article, that a reduction in lifetime exposure to high blood pressure and lifetime exposure to LDL-C particles reduces cardiovascular events like heart attacks and strokes by huge amounts.  Again, it’s the reduction of total lifetime exposure.  There’s some nuance to it, but basically, the reduction of systolic blood pressure (that’s the first number, or top number) of 5 mmHg over a lifetime and a reduction of LDL-C by 22.4 mg/dL over a lifetime reduces risk of cardiac and vascular events by 53%.  53% is huge.  And it does seem to track that reduction by 1 mmHg and 5 mg/dL also makes a difference, just not quite as big.  And each one, independent of the other, reduces risk.  10 mmHg blood pressure reduction over a lifetime alone reduces risk by 45% and 38.7 mg/dL LDL-C reduction, alone, over a lifetime reduces risk by 54%.  Extrapolating the data shows that doing both of those things- both reducing blood pressure by 10 mmHg and reducing LDL-C by 38.7 mg/dL reduces risk of a cardiovascular event by 78%.  That’s like, as close to a guarantee as you’re going to get.

It’s almost unbelievable.  78% risk reduction.  Who wouldn’t want those odds?  But it’s true because it’s not just from better physiologic function today or for 12 months, but over a lifetime.  The epithelial cells that line our blood vessels are susceptible to both mechanical damage from high blood pressure and chemical damage by inflammation and high levels of sticky LDL-C or apoB lipid particles, so lowering the risk of damage every day for a lifetime matters a lot.  This means that those numbers, even if only slightly elevated, still matter.  Members of your healthcare team might not be overly concerned, because you’re not going to stroke out today.  And maybe your ACVD calculator score isn’t too bad either.  But you’re not playing the today game or the 10 year game.

Compounding Marginal Gains In Other Areas of Life

You’re an elite contender in the game of life.  You’re headed for millionaire estates, not countryside acres.  You’re in it to win it. You visit your inlaws, win the talent show, learn sign language and CPR.  Maybe you’re even going to find a buried treasure or inherit a skunk farm.  You plan ahead and you care about way more than just short term risk.  The stress to your endothelium from 1 mmHg higher blood pressure and 5 mg/dL high apoB cholesterol matters.  And other seemingly little things matter, too, when you’re playing the long game.  Lifetime exposure to chronic low-grade inflammation matters.  This can come from a leaky gut, which you might not know you have.  I believe that your lifetime exposure to processed foods matters.  We do know that it takes around 2 years to change out the oils in  your cell membranes when you start eating different fats, so lifetime exposure to the kinds of fats that cause your cell membranes to perform poorly matters.  One basket of fried food matters, but the fewer fried foods you’ve eaten in your lifetime, the less of an impact one indulgence food will create. 

I also believe that your lifetime exposure to insulin matters.  You’ll die without it, ofcourse, but when you have higher than optimal levels, poor physiologic functioning will result.  The bigger your lifetime exposure to high levels, the worse your long term outcomes will be.  One blood sugar spike after a starchy meal matters, because it adds to your lifetime exposure.  Very slightly elevated insulin levels matter when you have those levels for 20 or 40 years.  I also think your lifetime exposure to sleep deprivation matters.  Matthew Walker points out the immediate effects of losing just one hour of sleep in his awesome book “Why We Sleep.”  Accident rates and heart attacks go up significantly when we all have to “spring forward” for daylight savings.  But sleep deprivation effects get even worse over time.  The more nights you are underslept, the higher your chances of weight gain, diabetes, cardiovascular disease, heart attack, stroke, depression, attention deficit, poor immune function and poor overall quality of life.

I believe that your lifetime exposure to sitting matters.  We know that sitting is the new smoking, so I think that we should all have to report our chair-year history on our health forms, like a pack-year history for smoking.  Exposure to sitting deteriorates your body the way exposure to space flight deteriorates your body.  It deprives your body of the benefits of gravity.  We talked all about it in episode 83, so you can listen to that one for more info.  Do you remember the way to prevent that lifetime exposure from being so detrimental?  Gold star if you know that all you need to do is stand up from your chair every 20 to 30 minutes.  That interrupts the onset of decrepitude and then you don’t have to have such a high chair-year history number, because I’m sure you were really worried about that.  But it really does matter.

Take the Lifetime View

I’m sure you can think of some other lifetime exposures that matter.  Unmanaged stress.  Traumatic events.  Overbreathing.  I’m just hoping that thinking of more things in terms of “lifetime exposure” helps you see how much little things matter.  1 mmHg more of blood pressure over a lifetime makes a measurable difference.  I believe that 20 minutes less sleep every night over a lifetime matters and 40 minutes more sitting every day over a lifetime matters.  These little things matter when we take the lifetime view.  Honoring the lifetime importance of little things also matters because it affirms our identity as a smart and forward-thinking lady who is aging at an elite level.  We don’t settle for average.  We care about more than just today or even 10 years from now.

I also believe that our lifetime exposure to clean air matters.  Our lifetime exposure to meditation really matters.  Our lifetime exposure to a healthy holobiome matters.  Our lifetime exposure to new ideas matters.  To healthy relationships.  And nutrient dense foods and healthy fats. To doing what we said we were going to do when we said we were going to do it whether we felt like it or not.  Our lifetime exposure to movement matters.  Both to training and to just not sitting still.  Our lifetime exposure to doing hard things matters.  To stepping out of our comfort zone.  To feeling our emotions instead of trying to push them away.  There are tons of others, some are my theories and lots of them are backed by studies, like lifetime exposure to saunas, exercise, and mindfulness.  

I’m hoping that you remember the importance of your lifetime exposure to tiny increases in blood pressure and aboB cholesterol particles, because that’s huge.  But also that you consider your lifetime exposure to other things and how a tiny improvement regularly over time can have massive effects on your quality of life in the future.  Sure, you can handle ever so slightly suboptimal circumstances, but what is a lifetime exposure to them going to cost you?  It’s worth it to be picky and put in the effort to make tiny improvements to get from Ok to to optimal.  You deserve it.  I’d love to help you get where you want to be.