Pursuit of longevity

The ultimate aim of medicine is not only to prolong life, but perhaps of even greater importance, to postpone suffering and disability, and assist in their management when they do occur. It has been estimated that after about the age of 60 the average person has to spend about one quarter of his or her remaining years with some disability. Yet healthy ageing is clearly possible as there are very marked differences between different individuals and between different communities (Khaw 1997).

Doll and Peto (1997) recently published a paper under the provocative title: `There is no such thing as ageing: old age is associated with disease but does not cause it'. It is however more helpful in clinical practice to regard ageing as having three components. First, there is involutionary decline or natural ageing which at present is neither understood nor preventable. Second, there are educational and social factors, the effects of which may well be powerful, but are not primarily the responsibility of the clinician. The third group of factors in ageing are pathological processes, which should all be either treatable or preventable and are very definitely within the province of clinical medicine.

Foremost among the pathological processes associated with ageing is vascular disease, comprising both atherosclerotic disease of the vessel walls and thrombosis within the vessel lumen. A major component of medical research should therefore be the identification and evaluation of both life-style and pathological processes in vascular disease. The patient him/herself should be able to exercise a measure of control over the first, while the task of physicians is to develop and provide means to limit, and perhaps avoid, the second.