Donald Trump, of all people, might make presidential health great again. As he faces another White House physical examination on Friday, Trump remains on track to become the nation's first senior-citizen president in more than 150 years to avoid suffering a medical crisis in office.
The odds may not be in this sedentary teetotaler's favor, however, and not just because he faces an estimated 1 in 50 chance of dying of natural causes over the next year. He has unhealthy habits, cardiologists and psychiatrists fret over the state of his heart and mind, and history is not on his side. Most presidents over the last century suffered from significant health scares or died while in office, and only one -- an often-ailing Ronald Reagan -- was older than Trump.
A medical briefing after Trump's White House physical in January 2018 revealed that he was taking three drugs: 10 mg/day of rosuvastatin (Crestor), low-dose aspirin for his cardiac health, and finasteride (Propecia) to prevent male pattern baldness.
Statistics released at that time included Trump's weight (239 lbs), height (6'3"), total cholesterol (223 mg/dL), triglycerides (129 mg/dL), HDL (67 mg/dL), LDL (143 mg/dL), and hemoglobin A1c (5%).
So-called "girthers" scoffed at the reported weight, which they believed was too low, and cardiologists interviewed by the New York Times warned that his LDL level seemed too high in light of his treatment with rosuvastatin. Meanwhile, a Brigham and Women's Hospital cardiologist plugged Trump's numbers into a risk calculator for MedPage Today and determined he had a "pretty high" 17% chance of a heart attack or other atherosclerotic cardiovascular disease event over the next 10 years.
"He's a ticking time bomb," internist Patricia Hale, MD, PhD, former associate medical director at New York's Albany Medical Center, told MedPage Today this week. "I never had a male patient live to their 90s with that lifestyle, no way. And certainly bad stuff started happening in their 70s. Usually, they died before they were 80."
But others aren't surprised by the president's apparent good health. "It's not unusual for a person in their 70s to go for 4 or more years without need of medical care," said cardiologist and presidential medical historian John Sotos, MD. "His threats, statistically, are atherosclerotic disease and cancer. But he takes a statin and certainly has his blood pressure followed, while his lifetime abstinence from tobacco and alcohol is a great benefit on the cancer side."
Sotos said finasteride would protect the presidential prostate (although the recommended dose of 1 mg is much less than that normally prescribed for prostate enlargement), and Trump is "not going to have activity-related problems, because he's not very active." However, he wondered if the president may have obstructive sleep apnea.
Presidents have suffered from a long list of medical challenges while in office, even in the modern era. Four died of apparent natural causes and four others were assassinated. And they've suffered a wide variety of serious ailments in the White House:
- Pneumonia (Washington)
- Stroke (Wilson)
- Depression (Pierce)
- Kidney disease (Arthur)
- Addison's disease and severe back pain (Kennedy)
- Gallbladder disease (Lyndon Johnson)
- Kidney stones (Andrew Johnson)
- Possible lead poisoning from an unremoved bullet (Jackson).
Hale, the New York internist, said medical threats facing Trump in light of his condition include dementia, diabetes, and cardiovascular and kidney problems.
"You can't take two statins and eat a cheeseburger and think you come out even," she said. "I wonder about mini-strokes. You slowly get dim-witted, and you end up with heart failure because you have microvascular disease."
With the sole exception of Trump, all six presidents since 1861 who were over the age of 64 in office suffered from notable medical problems during their terms. These include Harry Truman's breathing difficulties (Harry Truman) and George H.W. Bush's atrial fibrillation that required two days of hospitalization. Most seriously, a stroke debilitated Woodrow Wilson, and Dwight Eisenhower endured a heart attack, stroke, and intestinal surgery. More recently, Ronald Reagan not only survived a serious bullet wound but also underwent a colectomy for cancer as well as prostate surgery.
Trump is 72. With the exception of Reagan, no other president has been older while serving in the White House.
Other recent presidents have suffered from injuries in office (a torn tendon for Bill Clinton, a basketball mishap requiring 12 stitches for Barack Obama), emergency hemorrhoid surgery (Carter), and a fainting spell linked to fatigue and a wayward pretzel (George W. Bush).
So should we be gobsmacked that Trump doesn't seem to have suffered from even a routine illness for more than 2 years? "It doesn't seem unusual at all," said Anupam B. Jena, MD, PhD, an associate professor at Harvard Medical School who's studied the lifespans of world leaders. "I would be surprised if he hasn't had an upper respiratory infection at all during his presidency, but the fact that he hasn't had a major adverse health event -- cardiovascular, cancer, or injury -- isn't that surprising. President Trump still is well below the average life expectancy for a male who has survived to his age."
Indeed, the Social Security Administration's life expectancy calculator, which only considers gender and date of birth, estimates men of Trump's age will live an average of 86 years.
Another online calculator also puts Trump's current life expectancy at 86 or 87, depending on how his activity level is defined, said Lyle H. Ungar, PhD, a professor of computer and information science at the University of Pennsylvania who built an earlier version of the calculator. He told MedPage Today that the president has a 2% chance of dying over the next year.
"Donald Trump has a number of things going for him," Ungar said -- his race, wealth, and education level -- "although he's male, and that's not so good."
In fact, Trump's estimated life expectancy is higher than that of the much-younger Obama (83), according to the Social Security calculator. But that's simply because Trump has made it to 72 and has fewer years left to die in, Ungar said.
The life expectancy calculator, which Ungar said represents state of the art technology, doesn't take diet, cholesterol levels, or specific diseases other than diabetes into account. The reason: It's hard to find factors that have significant effects on lifespan overall, Ungar said.
Many presidents have made it into their 90s, including Jimmy Carter, George H.W. Bush, Gerald Ford, Ronald Reagan, John Adams, and Herbert Hoover, and another five made it past 80.
Still, Hale pointed out that much about Trump's health is unknown.
"Lifestyle trumps everything, literally and figuratively, sorry to use the word," she said. "It's extremely unlikely that he'll end up building houses in his 90s. Tick tick tick."
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