8/26/2026

I have been sharing my thoughts on Eric Topol's Super Agers: An Evidence-Based Approach to Longevity since August 14. Before I move on from this book, I want to mention something from Chapter 5, Cardiovascular Disease, that is very relevant.

A few days ago, I read about the widely discussed death of Chen Mao (陈毛), a 57-year-old amateur marathon runner from Dazhou, Sichuan, China.

According to reports, Chen died in his sleep on the morning of August 14, 2026, reportedly from acute myocardial infarction. (凤凰网)

What makes his story so shocking is how an exceptionally fit person suddenly died.

Chen began systematic long-distance running at age 50. Over the following seven years, he accumulated more than 30,000 kilometers of running and earned nearly 100 race medals. His best times were an impressive 2:55 for the full marathon and 1:21 for the half marathon. He also did strength training and was known for his muscular physique, disciplined lifestyle, and reportedly low resting heart rate of around 44 beats per minute. Reports also say he did not smoke or drink. (凤凰网)

As recently as August 13, the day before his death, he was still discussing training and race plans with other runners online. (Sohu)

Why has his death attracted so much attention?

Because it challenges an assumption many of us carry:

If someone looks extremely fit, performs at a high athletic level, and lives a disciplined lifestyle, surely his heart and arteries must be healthy.

But those are not necessarily the same thing.

1. A strong body does not necessarily mean healthy coronary arteries

Chen's muscular physique and exceptional running ability tell us a great deal about his physical conditioning. They do not, by themselves, tell us whether he had coronary atherosclerosis.

This is precisely what struck me when I looked at the coronary atherosclerosis data I wrote about yesterday.

Atherosclerosis can begin surprisingly early in life and progress silently for decades. A person can be physically fit and have no obvious symptoms while plaque is developing inside the coronary arteries.

That is an uncomfortable distinction:

The muscles we can see are not the same as the arteries we cannot see.

2. Excellent endurance does not make someone immune to cardiovascular disease

Exercise is one of the most powerful tools we have for healthy aging. Nothing about Chen Mao's story should be interpreted as an argument against exercise.

Quite the opposite.

But excellent athletic performance should not be mistaken for a shield against cardiovascular disease.

A low resting heart rate, strong muscles, fast marathon times and impressive endurance are all signs of physical conditioning. They do not completely eliminate other cardiovascular risk factors, including age, LDL cholesterol, blood pressure, diabetes, smoking history, family history and other factors.

This distinction becomes increasingly important as we get older.

3. Atherosclerosis can remain silent

One of the frightening characteristics of coronary atherosclerosis is that it may develop without any symptoms.

A person can feel completely normal while plaque is silently accumulating inside the arteries.

A heart attack does not necessarily mean that the disease suddenly appeared that day. In many cases, the underlying process may have been developing for years.

When an unstable atherosclerotic plaque ruptures, a blood clot can form at the site and suddenly obstruct blood flow to the heart muscle, producing an acute myocardial infarction. That is one possible mechanism behind a sudden heart attack.

Exercise is generally protective of cardiovascular health. But exercise is not a guarantee against cardiovascular disease.

4. The real lesson for us

What I take from Chen Mao's story is:

Don't confuse fitness with immunity.

Exercise that we should! But as we get older, especially if we undertake vigorous endurance training, we should also pay attention to cardiovascular risk factors and appropriate medical evaluation.

Know your blood pressure, your blood sugar, your family history, your risk, your cholesterol—and, when appropriate, your ApoB or other cardiac markers that your doctor recommends. Pay attention to symptoms.

And if you are planning intensive endurance training, particularly in middle age or later, discuss your cardiovascular risk and what screening is appropriate with your doctor rather than assuming that excellent fitness makes testing unnecessary.

Yesterday I wrote about coronary atherosclerosis in young people. The heart attack like Chen's may happen at 57, but the underlying disease process may have started decades earlier.

The most important lesson I take from Chen Mao's tragic story:

Don't be blinded by athletic performance, a low resting heart rate, or a lean and muscular physique. They may be signs of "fitness"—but they are not necessarily healthy coronary arteries.

And the broader lesson from Super Agers is even more important:

Healthy aging is not just looking healthy. It is preserving health at every level—especially the parts of our bodies that we cannot see.

8/25/2026

I have been sharing my thoughts on Super Agers: An Evidence-Based Approach to Longevity by Eric Topol since August 14. Before I move on from this book, I want to share one more thing that caught me completely by surprise in Chapter 5, “Cardiovascular Disease.”

I was shocked when I saw the following data, from a study examining the prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults using intravascular ultrasound.

The graph at the bottom clearly shows something I had never thought about this way before:

Coronary atherosclerosis can begin much earlier in life than most people assume.

What does the graph show?

The y-axis represents the percentage of people with coronary atherosclerosis, and the x-axis represents age.

The researchers used two thresholds for defining an atherosclerotic lesion:

The pattern is striking. Even among teenagers aged 13–19, 17% met the 0.5-mm threshold and 21% met the 0.3-mm threshold.

Among people in their 20s, the numbers rose to 37% and 66%.

By the 30s, they reached 60% and 75%.

By age 40–49, the figures were 71% and 85%.

And among people 50 and older, they were 85% and 91%.

The most shocking part for me

The 20–29 age group really caught my attention. These are still very young people. Yet even using the stricter 0.5-mm threshold, more than one-third already showed coronary atherosclerosis. Using the 0.3-mm threshold, the figure was two-thirds.

And among people in their 30s—still young by any ordinary definition—the numbers were already 60% and 75%.

I used to think of coronary atherosclerosis primarily as a disease of old age. Now I understand it differently:

Atherosclerosis can be a lifelong process that begins early and accumulates over decades.

The graph shows the presence of atherosclerotic changes according to specific anatomical thresholds. But it does not tell us how severe the plaque is, whether an artery is significantly narrowed, whether the person has symptoms, or whether that person will eventually suffer a heart attack.

So having detectable atherosclerosis is not the same as having clinically significant coronary artery disease. But the finding is still eye-opening.

Why does it become more common with age?

There are several reasons that make sense.

1. It is cumulative.

Our arteries are exposed year after year to factors such as LDL cholesterol, blood pressure, elevated blood glucose, smoking, inflammation, and other metabolic stresses.

A 50-year-old has had decades of exposure that a 20-year-old has not.

2. The process can go on silently.

Atherosclerosis does not suddenly appear when someone has a heart attack. Arterial changes can develop silently for years or even decades before they cause symptoms.

A heart attack may be the first obvious sign of a disease process that has been developing for a very long time.

3. Risk factors can accelerate the process.

Smoking, high LDL or ApoB, hypertension, diabetes, obesity, poor diet, and physical inactivity can all contribute to the progression of cardiovascular disease.

This is why waiting until middle age to start thinking about healthy lifestyle and cardiovascular prevention may be too late to prevent the beginning of the process. By then, it may already have been developing for decades.

4. The threshold matters.

The 0.3-mm threshold is more sensitive than the 0.5-mm threshold, which explains why the percentages are consistently higher with the smaller threshold.

So these numbers should not be interpreted as saying that two-thirds of people in their 20s have serious heart disease. They indicate that detectable atherosclerotic changes are surprisingly common.

5. This is not just an “old people's disease”

We often think about healthy aging as something that becomes important when we reach our 60s or 70s.

But many processes associated with age-related disease begin much earlier.

The same principle applies to cardiovascular disease:

A heart attack may happen at 65, but the underlying disease process may have started decades earlier.

The absence of symptoms does not necessarily mean that everything is fine inside the body.

That gives a different meaning to the lifestyle factors Topol discusses throughout Super Agers: diet, exercise, not smoking, maintaining healthy blood pressure and cholesterol, getting adequate sleep, and maintaining good metabolic health.

These habits are important not only because they help us feel better today. They influence the trajectory of disease accumulation over the decades ahead.

The message I take away

This graph gave me a completely different perspective on prevention.

You are shaping and influencing what is happening inside your arteries right now.

And perhaps that is one of the most important lessons of healthy aging:

You don't start preparing for healthy aging when you become old. You start young.

8/24/2026

This is the 11th piece in my series about Eric Topol's book, Super Agers: An Evidence-Based Approach to Longevity.

This section emphasizes something that is often overlooked when talking about healthy aging: our social connections, economic circumstances, and daily habits all interact to shape our healthspan.

1. Loneliness and social isolation are serious health risks

A systematic review of 90 cohort studies involving more than 2.2 million people found that loneliness was associated with a 32% higher risk of all-cause mortality, 34% higher cardiovascular mortality, and 24% higher cancer-related mortality.

Topol is careful to point out that these are associations, not proof that loneliness directly causes these outcomes.

Social isolation can take many forms: living alone, having little contact with family or friends, or lacking regular participation in social groups. Obesity is also associated with greater loneliness and social isolation.

Topol raises an intriguing possibility: Could generative AI eventually help reduce loneliness? Early research is encouraging, but it is far too preliminary to draw firm conclusions. For now, AI might be viewed as a possible supplement to—not a replacement for—human relationships.

2. Health is shaped by socioeconomic circumstances

Topol makes an important point: healthy aging is not simply a matter of individual choices.

Socioeconomic status is an independent risk factor for premature mortality and can have an impact comparable to major risk factors such as smoking, heavy alcohol use, hypertension, diabetes, and physical inactivity.

People with lower socioeconomic status are more likely to experience poor diet, inadequate sleep, greater exposure to air pollution, and less opportunity for physical activity.

Education matters as well. One systematic review found a dose-response relationship between education and mortality, with mortality risk falling by about 2% for each additional year of education.

This means that improving population health requires more than telling people to “eat better” or “exercise more.” People also need the social and economic conditions that make healthy choices possible.

3. Food access matters—not just food choices

This is the first time I have encountered the term “food desert.”

A food desert is an area where people have limited access to fresh, healthy, and affordable food, often because there are few nearby supermarkets or grocery stores. Residents may instead rely on convenience stores and fast-food outlets, where highly processed foods are easier to find.

Topol points out that the United States has thousands of food deserts, while more than 50 million Americans experience food insecurity.

Food insecurity itself has been associated with substantially higher premature mortality. Although “food-as-medicine” programs have attracted considerable attention, randomized trials have not yet demonstrated clear improvements in clinical outcomes.

So the larger issue is whether people can afford healthy food, access it, and incorporate it into their daily lives.

4. The real intervention is the whole lifestyle

Topol brings together all the factors he has discussed under the broader concept of “Lifestyle+.” The idea is that healthy aging does not depend on one behavior. Diet, exercise, sleep, stress, social connection, economic status, education level, alcohol, smoking, and environmental exposures all interact with one another.

The evidence is loud and clear:

• Adopting an optimal diet from age 20 was modeled to add more than 10 years of life expectancy for Americans.

• Adopting a healthy diet at age 40 was modeled to add about 9 years.

• Not smoking, avoiding obesity, and limiting alcohol were associated with about 7 additional years of life.

• Among more than 700,000 U.S. veterans, eight favorable lifestyle factors—not smoking, physical activity, no excessive alcohol consumption, restorative sleep, good nutrition, stress management, social connection, and no opioid disorder—were associated with as much as 24 additional years of life expectancy for men and 20.5 years for women at age 40.

• A healthy lifestyle was also associated with 8–10 additional years free of cancer, cardiovascular disease, and type 2 diabetes at age 50.

• Favorable lifestyle factors were associated with lower dementia risk even among people with a high genetic risk.

While these numbers are not guaranteed, they illustrate the remarkable cumulative power of lifestyle.

5. Lifestyle can modify genetic risk

Another encouraging message is that genetic predisposition does not necessarily determine destiny.

Genes influence our susceptibility to disease, but lifestyle can modify that risk. Topol cites UK Biobank research showing that favorable lifestyle factors were associated with reduced risk across more than 40 diseases, even among people with greater genetic susceptibility.

While we can't choose our genes, we can influence how those genes interact with our environment and behavior.

The big picture

Topol gradually brings everything together in this section: not one single factor but all of factors work together to create a “Lifestyle+” package.

Many of these interventions are remarkably low-tech and common sense. which we have known since ancient time. What modern research has done is quantify their effects and show how broadly they influence health.

Topol argues strongly: It may be difficult for any single drug or medical intervention to match the enormous combined impact of a well-guided healthy lifestyle. And that may be the most important lesson of Super Agers.

8/23/2026

This is the 10th piece in my series about Eric Topol's book, Super Agers: An Evidence-Based Approach to Longevity.

Environmental Toxins

So far, I have mostly focused on things we can control—what we eat, how much we exercise, how well we sleep, and when we eat. This section takes a different perspective: the environment around us can also have a profound impact on our health.

1. Air pollution is a major global health threat

Particulate matter (PM)—especially fine particles such as PM2.5 and PM10—along with nitrogen dioxide and ozone, contributes substantially to premature death and disease.

Topol cites evidence that short-term exposure to fine PM is associated with about one million deaths worldwide each year. There is also no clearly established safe threshold for the long-term cardiovascular effects of PM2.5.

Chronic exposure to fine PM has been associated with roughly 20% of type 2 diabetes cases. Air pollution can affect multiple organ systems through inflammation, oxidative stress, immune dysfunction, and changes that promote blood clotting. It has been associated with cardiovascular and respiratory disease, lung cancer, cognitive decline, and even a weaker immune response to vaccination.

Outdoor air pollution is estimated to contribute to more than 8 million premature deaths each year. Climate change, wildfires, and extreme heat are making the problem even worse.

2. Indoor and residential environmental toxins also threaten health

Some important risks are much closer to home:

• Secondhand smoke is associated with heart disease, stroke, type 2 diabetes, asthma, and breast cancer.

• Radon, an odorless radioactive gas, increases the risk of lung cancer, particularly among nonsmokers. Yet most American homes have never been tested for radon.

• Pesticides have been associated with various cancers, diabetes, Parkinson's disease, cognitive impairment, reproductive problems, and other health conditions. However, Topol notes that the evidence for some of these associations is supportive rather than definitive.

3. Noise pollution affects more than our hearing

Chronic noise pollution—particularly at night can increase stress hormones and inflammation and is associated with high blood pressure, heart disease, and type 2 diabetes.

Topol notes that about 100 million Americans are exposed to continuous daily noise levels above 70 decibels.

4. Microplastics and nanoplastics are becoming a major concern

This may be one of the most disturbing parts of the chapter.

Plastic production has increased enormously, and microplastics and nanoplastics have become widespread in our food, water, and air. They have now been detected in many parts of the human body, including arteries, blood clots, the brain, liver, lungs, intestines, placenta, and testes.

In one study of patients undergoing carotid artery surgery, microplastics were found in arterial plaques. Their presence was associated with greater arterial inflammation and a more than fourfold higher risk of heart attack, stroke, or death during three years of follow-up.

Other studies have reported associations between microplastic exposure and lower sperm counts, inflammatory bowel disease, asthma, cancer, cognitive decline, infertility, and adverse pregnancy outcomes.

The important word here is "associated." Much of this research is still emerging, and the presence of microplastics does not by itself prove that they caused these diseases.

Topol suggests some practical ways to reduce exposure: avoid storing food in plastic containers when possible, limit buying fast food, use glass or stainless-steel water bottles, and choose wooden or metal kitchen utensils.

5. PFAS: the "forever chemicals"

PFAS are synthetic chemicals with extremely strong chemical bonds that allow them to persist in the environment for a very long time.

They are widespread in drinking water and consumer products, and almost all Americans have measurable PFAS in their blood.

High exposure has been associated with kidney and testicular cancer, high blood pressure, pregnancy complications, high cholesterol, and damage to the liver, brain, thyroid, and immune system.

PFAS can be found in a surprisingly wide range of products, including nonstick cookware, fast-food packaging, clothing, carpets, dental floss, and some plastic bags.

There are tens of thousands of different PFAS compounds, while regulatory standards currently cover only a small number of them.

6. Other environmental exposures

Topol also raises concerns about unnecessary exposure to ionizing radiation, including from CT and nuclear imaging, because cumulative exposure may increase cancer risk.

He also discusses metals such as cadmium, tungsten, uranium, cobalt, copper, and zinc. Higher levels of these metals were associated with increased cardiovascular events and all-cause mortality in a large prospective study.

7. The bigger picture

Topol's larger message is that healthy aging is not determined solely by our personal lifestyle choices.

We can eat well, exercise, sleep adequately, and maintain a healthy weight, yet we are still exposed to pollutants and chemicals in the air we breathe, the water we drink, the food we eat, and the products we use every day.

These environmental exposures may add to the health risks already associated with poor diet and other lifestyle factors. Topol even raises the possibility that environmental factors may contribute to the concerning rise in certain cancers among younger adults, although that remains an area for further research.

The takeaway

We cannot eliminate every environmental toxin from our lives. But we can become more aware of them and make sensible choices to reduce unnecessary exposure.

8/22/2026

This is the ninth piece in my series about Eric Topol's book, Super Agers: An Evidence-Based Approach to Longevity. This section focuses on sleep.

1. Sleep is essential to healthy aging

Sleep is a fundamental biological requirement, regulated by our circadian rhythm and the body's central biological clock.

Poor sleep is associated with a remarkably wide range of health problems, including cardiovascular disease, cancer, diabetes, obesity, impaired immunity, Alzheimer's disease, stroke, and mental-health problems.

Topol cites several striking findings:

• Sleeping fewer than six hours at ages 50–60 was associated with a 30% higher risk of dementia.

• Sleep deprivation triggers harmful inflammatory changes throughout the body.

• The loss of one hour of sleep associated with the spring daylight-saving-time change has been linked to a temporary increase in heart attacks.

• Improving sleep in people who normally sleep too little reduced their daily calorie intake by about 270 calories.

• Greater irregularity in sleep schedules is also associated with higher mortality.

2. One of sleep's most important biological functions: cleaning the brain

One of the most fascinating points in the chapter is the role of the glymphatic system.

During sleep, particularly deep non-REM sleep, cerebrospinal fluid moves through the brain and helps clear metabolic waste.

Even one night of sleep deprivation can impair this waste-clearance process and increase beta-amyloid levels, a protein associated with Alzheimer's disease.

In other words, sleep is not simply a period of rest. The brain is doing important maintenance work while we sleep.

3. About seven hours appears to be just right

Topol discusses large studies suggesting that roughly seven hours of sleep per night is associated with the best health outcomes.

Both too little and too much sleep are associated with increased risk.

In one large analysis:

• Each hour below the seven-to-eight-hour range was associated with about a 6% higher cardiovascular risk.

• Each hour above that range was associated with about a 12% higher cardiovascular risk.

Long sleep was also associated with higher all-cause mortality and poorer cognitive and mental-health outcomes.

4. Regularity matters

Topol discusses the sleep regularity index and notes that people with more regular sleep schedules had lower mortality.

His advice is: try to maintain roughly the same sleep schedule every day, including weekends.

It is not only how long you sleep, but also how consistently you sleep.

5. Aging makes good sleep more difficult

Unfortunately, sleep becomes increasingly important as we age.

Older adults tend to experience:

• less deep sleep

• more fragmented sleep

• lower sleep efficiency

• earlier bedtimes

• earlier awakenings

• changes in circadian timing.

That makes protecting sleep especially important in later life.

6. America has a widespread sleep deficiency

Topol points out that roughly 35–40% of American adults regularly sleep fewer than seven hours a night.

Americans also rank among the populations with the shortest sleep duration studied.

So inadequate sleep is not simply an individual problem. It is a widespread public-health issue.

7. Circadian rhythm and meal timing matter

I found this part particularly interesting because it connects directly with the previous section on caloric restriction and early dinner.

Our circadian clock influences virtually every organ system, including the gut, liver, muscles, immune system, and heart.

The gut microbiome also follows daily rhythms. Irregular meal timing can disrupt these internal clocks and contribute to impaired glucose regulation.

This is why Topol recommends maintaining a consistent daily pattern of eating and leaving several hours between dinner and bedtime.

In other words, when we eat may matter almost as much as what we eat.

8. For insomnia, CBT-I comes first

Topol emphasizes that the first-line treatment for chronic insomnia should be cognitive behavioral therapy for insomnia (CBT-I) rather than immediately turning to medication.

Digital, app-based CBT-I has also shown benefits in large trials.

By contrast, evidence for supplements such as melatonin, magnesium, and ashwagandha is relatively weak, with generally modest effects. Topol is also skeptical of expensive high-tech sleep products when strong evidence of benefit is lacking.

And there is an interesting warning about sleep trackers: they aren't necessarily precise, and becoming obsessed with sleep scores can actually create anxiety and make sleep worse.

9. Simple sleep habits still matter

Topol's practical advice:

1. Keep a consistent sleep schedule.

2. Exercise regularly.

3. Eat on a consistent schedule and finish dinner several hours before bedtime.

4. Keep the bedroom cool, dark, and quiet.

5. Limit exposure to blue light from electronic devices before bed.

Sometimes the most effective interventions are also the least complicated.

10. Don't overlook sleep apnea

Sleep apnea is common, particularly among older adults, and many people with it may not experience obvious daytime sleepiness.

Warning signs include loud snoring, gasping or choking during sleep, pauses in breathing, and disrupted sleep.

Topol emphasizes that untreated symptomatic sleep apnea is associated with at least a twofold higher risk of cardiovascular and metabolic disease.

The big picture

Topol's message is that sleep is an active biological process essential to maintaining the brain, heart, metabolism, immune system, and overall health.

For healthy aging, his practical formula is:

Sleep about seven hours, keep a regular schedule, eat earlier, exercise regularly, protect your sleep environment, and take possible sleep apnea seriously.