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Disease prevention

An ounce of prevention is worth a pound of cure. So what are the diseases we should be preventing? The table below lists the top 10 causes of death in the United States1.

CAUSE OF DEATH TOTAL DEATHS (2002)
Heart disease 28.5%
Cancer 22.8%
Stroke 6.7%
Chronic lower respiratory diseases 5.1%
Unintentional injuries 4.4%
Diabetes 3.0%
Influenza and pneumonia 2.7%
Alzheimer’s disease 2.4%
Kidney disease 1.7%
Septicemia (blood infection) 1.4%
All other causes 21.3%

Heart disease and cancer are the big killers, accounting for more than 50 percent of all deaths. You probably know at least one family member or friend who has battled cancer or suffered a heart attack. Overall, the top 10 diseases are responsible for almost 80 percent of all deaths. Now that we know what kills us, how can we prevent ourselves from dying from these diseases? Thanks to billions of dollars of research, scientists have discovered the major risk factors and disease-preventing behaviors for the top causes of death. Let’s start with heart disease and then move down the list.

The first wealth is health.
-Ralph Waldo Emerson

Heart Disease
The most common heart diseases are Coronary Heart Disease (CHD), Heart Failure, and Hypertension (high blood pressure). Many people suffer from heart disease but have no symptoms. In some cases, a heart attack is the first sign of CHD. The table below lists the major modifiable lifestyle factors for the most common types of heart disease.

PERCENTAGE OF ALL HEART DISEASEMODIFIABLE LIFESTYLE FACTORS
Coronary Heart Disease (CHD)
(71%)
• Exercise, healthy diet, and non-smoking: 82% less heart disease in women2
• Lack of exercise accounts for 37% of deaths3
• Smoking accounts for 20% of deaths4
• Absence of high blood pressure, high cholesterol, and smoking: 77–92% less death (5.8–9.5 years longer life expectancy)5
Heart Failure
(8%)
• Heart disease accounts for 52% of cases6
• Obesity accounts for 11–14% of cases7
Hypertension
(7%)
• Healthy diet lowers systolic and diastolic pressure by 11.4 and 5.5 mm Hg, respectively8
• Exercise lowers systolic and diastolic pressure by 9.9 and 5.9 mm Hg, respectively9
• Weight loss: 21% lower risk10
• Low salt diet: 20% lower risk11
All Heart Disease• Obesity and lack of exercise account for 59% of all deaths from heart disease12
• Low salt diet: 25% lower risk13

You’re much more likely to get heart disease if you smoke, don’t exercise, eat a high-salt diet, suffer from obesity, have high blood pressure, or high cholesterol. But it’s almost entirely avoidable with the right behaviors, such as a diet high in fruits and vegetables, regular exercise, not smoking, and weight control. Unfortunately, only 9 percent of middle-aged Americans live a healthy lifestyle. But it’s never too late to start. In a study from the Medical University of South Carolina, researchers followed a group of people who started living a healthy lifestyle only after the age of 4514. Over a 4-year period, subjects lowered their risk of heart disease by 35 percent, and their risk of death by 40 percent.

Screening for Heart Disease
The American Heart Association recommends that doctors regularly measure Body Mass Index (BMI) and blood pressure for all adults over the age of 2015. A lipid profile test is also recommended every 5 years to screen for high cholesterol. If you don’t know your BMI, blood pressure, or cholesterol levels, book an appointment with your doctor and find out as soon as possible.

Cancer
The second biggest killer is cancer. Four cancers—lung, colorectal, breast, and prostate—account for almost two-thirds of all cases. The table below lists the major modifiable lifestyle factors.

PERCENTAGE OF ALL CANCERSMODIFIABLE LIFESTYLE FACTORS
Lung
(30%)
• Smoking accounts for 89% of deaths16
Colorectal
(24%)
• Regular exercise: 50% lower risk17
• Obesity: 50% increased risk in women, 80% in men18
Breast (women)
(15%)
• Obesity accounts for 10% of postmenopausal cases19
• Alcohol: 10% higher risk20
• Regular exercise: 14% lower risk21
• Obesity, alcohol, and lack of exercise account for 27% of risk22
Prostate (men)
(9%)
• Selenium supplementation: 63% lower risk23
• Vitamin E supplementation: 41% less death23
• Fish high in omega-3 fatty acids: 2–3-fold lower risk24
All Cancers• Poor diet and lack of exercise account for one-third of all cancer cases25
• Smoking accounts for an additional one-third of all cases25
• Healthy diet prevents 35% of all cancer26
• Obesity accounts for 14% of all cancer deaths in men, 20% in women27

Smoking, obesity, lack of exercise, and poor diet dramatically increase the risk of cancer. Scientists estimate that 30–40 percent of all cancer is preventable with healthy diet, regular exercise, and weight control. Another one-third is preventable by not smoking. This means that 60–70 percent of cancers are preventable by living a healthy lifestyle.

The doctor of the future will give no medicine, but instead will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease.
-Thomas Edison

Screening for Cancer
Even if you lead a healthy lifestyle, you still have a small risk of getting cancer. Screening detects cancer early, before it has a chance to grow and spread. This significantly reduces your risk of death from cancer. The following table describes the screening methods recommended by the American Cancer Society. Note that cervical cancer is almost entirely treatable if detected early by Pap tests. Talk to your doctor, and make sure you’re getting the screening tests that are recommended for you.

TYPE OF CANCERSCREENING METHODRISK REDUCTION
Breast (women)• Age 20–39: clinical breast exam every 3 years
• Age 40 and older: breast exam and mammography every year
45% less death28
Cervical (women)• Age 21 or younger: annual Pap test
• After age 30: Pap test every 2–3 years
94% fewer cases29
ColorectalStarting at age 50, your choice of:
• Annual fecal occult blood test (FOBT)
• Flexible sigmoidoscopy every 5 years
• Double-contrast barium enema every 5 years
• Colonoscopy every 10 years
33% less death30
Prostate (men)Starting at age 50: consider annual Prostate Specific Antigen (PSA) test and digital rectal exam62% less death31

Preventing Other Diseases
Most heart disease and cancers are preventable, or at least treatable if detected early. The same holds true for other diseases in the top 10, as you can see from the table below.

CAUSE OF DEATHMODIFIABLE LIFESTYLE FACTORS
Stroke• High blood pressure, high cholesterol, overweight, low fruit and vegetable intake, physical inactivity, tobacco, and alcohol account for 71–79% of deaths32
• Lowering high blood pressure: 35–45% lower risk33
• Diet high in fruits and vegetables: 25–35% lower risk34
Motor Vehicle Accidents• Seatbelts: 45% lower risk of death35
• Alcohol is involved in 40% of deaths36
• Side airbags (head and torso): 37% lower risk of death37
Type 2 Diabetes • Obesity accounts for 75% of risk38
• Regular exercise and weight loss: 60% lower risk39
Influenza and Pneumonia• Flu vaccination reduces hospitalization by 63%40
Alzheimer’s Disease
• Diet high in fish and omega-3 fatty acids: 60% lower risk41
• Brain-stimulating activities: 47% lower risk42
• Regular exercise: 32% lower risk43

Recommendations
The top 10 diseases account for almost 80 percent of deaths. But most of them are preventable with a few simple behaviors. Here is a summary of the top eight recommendations to prevent disease:
  • Eat healthy.
  • Get regular exercise.
  • Lose weight if you’re obese.
  • Don’t smoke or chew tobacco.
  • Drink one alcoholic drink or less per day44.
  • Get screened for heart disease and cancer.
  • Always wear your seatbelt, and don’t drink and drive.
  • Get your flu shot every year.

References
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  4. Centers for Disease Control and Prevention. Smoking-attributable mortality, morbidity, and economic costs (SAMMEC): adult SAMMEC and maternal and child health (MCH) SAMMEC software, 2002c. http://www.cdc.gov/tobacco/sammec
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  8. Appel LJ et al. (1997). A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med. 336(16):1117–24.
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  22. Danaei G et al. (2005). Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. Lancet. 366:1784–93.
  23. Moul JW et al. (2003). Early prostate cancer: Prevention, treatment modalities, and quality of life issues. European Urology. 44:283–293.
  24. Terry P et al. (2001). Fatty fish consumption and risk of prostate cancer. Lancet. 357: 1764–1766.
  25. Byers T et al. (2002). American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 52:92–119.
  26. World Cancer Research Fund/American Institute for Cancer Research. (2007). Food, nutrition, physical activity, and the prevention of cancer: a global perspective. AICR.
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  28. Tabar L et al. (2003). Mammography service screening and mortality in breast cancer patients: 20-year follow-up before and after introduction of screening. Lancet. 361:1405–10.
  29. Waxman AG. (2005). Guidelines for cervical cancer screening: history and scientific rationale. Clin Obs Gyn. 48(1):77–97.
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  31. Labrie F et al. (2004). Screening decreases prostate cancer mortality: 11-year follow-up of the 1988 Quebec prospective randomized controlled trial. Prostate. 59:311–318.
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  34. Sauvaget C et al. (2003). Vegetable and fruit intake and stroke mortality in the Hiroshima/Nagasaki life span study. Stroke. 34:2355–2360.
  35. Dinh-Zarr TB et al. (2001). Reviews of evidence regarding interventions to increase the use of safety belts. Am J Prev Med. 21(4S):48–65).
  36. U.S. Department of Health and Human Services. (2000). Healthy people 2010: Understanding and improving health. 2nd ed. U.S. Government Printing Office.
  37. Insurance Institute for Highway Safety. (2006). Surviving side crashes. Status Report. 41(8):1–7.
  38. Hu FB et al. (2001). Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 345:790–97.
  39. Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of Type 2 Diabetes with lifestyle intervention or metformin. N Engl J Med. 346(6):393–403.
  40. Ahmed AH et al. (1997). Effectiveness of influenza vaccine in reducing hospital admissions during the 1989–90 epidemic. Epidemiol Infect. 118:27–33.
  41. Morris MC et al. (2003). Consumption of fish and n-3 fatty acids and risk of incident Alzheimer Disease. Arch Neurol. 60: 940–946.
  42. Wilson RS et al. (2002). Participation in cognitively stimulating activities and risk of incident Alzheimer Disease. JAMA. 287(6): 742–748.
  43. Larson EB et al. (2006). Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann Intern Med. 144(2):73–81.
  44. Thun MJ et al. (1997). Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med. 337(24):1705–14.

Copyright © 2009 by Paul Lem, M.D.
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