I’d like you to meet Mrs. L.R., a 98-year-old patient who has enjoyed remarkable health throughout her life. Her primary care physician referred her to me to investigate swelling in her legs, also known as edema. During our initial meeting, I noted she arrived alone, driving herself to the medical center. I soon discovered she’s an exceptionally active and healthy woman who lives independently, maintains a wide social circle, and values her alone time.
Her exceptional health is not typical for her family. Her mother passed away at 59, her father at 64, and her two brothers at 43 and 75. Three years prior to our meeting, her husband died at 97. He also enjoyed a similar long health span, which contrasted with his parents and siblings, who experienced chronic illnesses and died much younger. After her husband’s death, Mrs. L.R. became depressed and lost 30 pounds. She lost interest in her hobbies like painting and jigsaw puzzles. However, she continued playing cards and Rummikub weekly with a group of eight women. One of these friends suggested she move to a senior living apartment after living in her house for decades. This move introduced her to new artists, new friends, and an expanded social circle. This helped her return to her “old” self, reviving her passions and regaining a healthy weight.
The purpose of the consultation was to determine the cause of her leg edema. Although she had no history of high blood pressure, an echocardiogram revealed a thickened heart with heart muscle function exceeding the normal range. Her ejection fraction, the amount of blood pumped out of the main chamber with each heartbeat, was abnormally high. I diagnosed diastolic dysfunction. Her heart had stiffened, making it difficult to relax. This explained the leg edema, which was treated easily and resolved within days. Mrs. L.R. is an example of a super ager. She’s an unusual person who has avoided the common diseases associated with aging, defying typical expectations for aging. Her and her husband’s extreme health span and longevity don’t seem to be due to genetics. Medical scientists don’t fully understand it but would conclude, based on our understanding of the biology of aging and the process of elimination, that it’s stochastic, a random occurrence of good luck.
In stark contrast, consider Mr. R.P., another patient I’ve been following for over 30 years. He is also 98 years old and has led a relatively healthy life. At 75, after undergoing coronary artery bypass surgery at 62, Mr. R.P. experienced chest pain during exertion. At that time, I placed two stents in one of his bypass grafts that had become blocked due to atherosclerosis, which restricts blood flow. He later developed rapid atrial fibrillation that didn’t respond to medication, requiring two ablation procedures to maintain a normal heart rhythm.
Years later, he had a shoulder replacement and suffered a minor stroke post-operatively. At 96, he was hospitalized with COVID-19 pneumonia and, despite a lengthy hospital stay, didn’t develop respiratory failure and fully recovered. Mr. R.P. showcases the achievements of modern medicine. He had severe atherosclerotic cardiovascular disease, but with repeated restoration of blood flow to his heart and aggressive secondary prevention, he remained well. He embodies the medical advancements made in treating age-related diseases.
What’s exciting now is that we can accurately predict heart disease and other major diseases of aging in high-risk individuals decades in advance, allowing for primary prevention, or at least a significant delay in their onset. Doctors can’t promise to reverse or stop aging, but we can promise that the second half of our lives will be healthier than that of previous generations. This is the type of longevity we will see more frequently in the future because of remarkable progress in lifestyle, cells, genomics, artificial intelligence, drugs, and vaccines. These factors interact: lifestyle influences our microbiome and cells. Our response to drugs and vaccines is affected by our genomics and cells, and the discovery of new drugs has been accelerated by gene variants and AI.
There are still considerable obstacles—including health disparities across the U.S.—but as we advance, we will inevitably see a reduction in age-related diseases that is currently unimaginable for many. Achieving the more ambitious goal of slowing the aging process itself will take years. However, when we do, super agers like Mrs. L.R. and Mr. R.P. will be viewed as ordinary, vibrant people making valuable contributions to society. I recently turned 70, and I hope that you and I will be among them.
From SUPER AGERS: An Evidence-Based Approach to Longevity by Eric Topol, MD. Copyright © 2025 by Eric Topol, MD. Reprinted by permission of Simon & Schuster, LLC.
