Strategies for longevity, years in development

Regarding the notion that prevention constitutes the finest medicine, JoAnn Manson is quite serious.

Since the 1980s, Manson has committed her career to unraveling intricate threads of human health, concentrating on factors within our influence: physical activity, nutrition, sleep, tobacco use, alcohol intake, medications like menopausal hormone therapy, low-dose aspirin, statins, and, most recently, vitamins and various dietary supplements.

“From the outset of my medical education, I’ve been amazed by the significant influence of changeable lifestyle elements as defenses against chronic illnesses,” stated Manson, who holds the position of chief of the Division of Preventive Medicine at Brigham and Women’s Hospital and the Michael and Lee Bell Endowed Professor of Women’s Health at Harvard Medical School. “I felt inspired to dedicate my research career to evaluating interventions aimed at minimizing chronic disease burden, prolonging years of good health or ‘healthspan,’ and striving to reduce early mortality.”

“From the outset of my medical education, I’ve been amazed by the significant influence of changeable lifestyle elements as defenses against chronic illnesses.”

A review of Manson’s publication record — one significant medical research database reveals more than 1,800 references to her name — resembles a compilation of national health headlines from the previous two decades: menopausal hormone therapy and cardiovascular disease and breast cancer; secondhand smoke in professional settings; moderate exercise versus vigorous activity in heart disease prevention; daily steps and cancer risk; pre-pandemic physical activity and the severity of COVID. As a member of the National Academy of Medicine, she is recognized by Research.com as the leading female scientist globally according to citation metrics, with over 369,000 citations and an h-index of 310, reflecting the breadth and significance of her work.

Her instruments include substantial randomized prevention trials and large longitudinal studies tracking tens of thousands of individuals over time, collecting health, diet, and behavioral data, often supplemented by blood, tissue, and other physical samples that enrich comprehension and provide tangible evidence of changes noted by participants. Many of these projects have garnered support from federal resources.

Manson’s research commenced with the groundbreaking Nurses’ Health Study, initiated in 1976, when the majority of study subjects were white males, aimed at addressing gaps in women’s health. The lengthy study, established by Brigham and Harvard researchers to investigate connections between contraceptive use, smoking, heart disease, and cancer, evolved over time to offer a comprehensive understanding of lifestyle and health. Manson has been associated with this project since the mid-1980s and has served as a principal investigator of the cardiovascular segment for 26 years.

In 1993, Manson became one of the primary principal investigators of a National Institutes of Health-supported study known as the Women’s Health Initiative, which enrolled 160,000 postmenopausal women across three significant randomized trials, alongside an inquiry into primary causes of chronic disease and mortality in older women, including cardiovascular disease, cancer, and osteoporosis. Manson oversees the study’s clinical center in Boston.

More recently, she has concentrated on what she has termed the “Wild West” of American healthcare — dietary supplements, whose health claims and distribution remain largely unregulated. In the nationwide VITAL randomized trial involving 25,000 men and women aged 50 and older, she and her colleagues assessed health claims related to vitamin D and omega-3 fatty acids, reporting in 2018 that omega-3 fatty acids from fish oil were linked to a 28 percent decrease in heart attacks. The effect was notably higher among those consuming minimal fish in their diet, reducing risk by approximately 40 percent. For vitamin D, there seemed to be little influence on heart disease, but a significant 17 percent reduction in advanced cancer and a 22 percent decrease in autoimmune disorders was observed.

A more recent randomized trial, COSMOS, the COcoa Supplement and Multivitamin Outcome Study, explored relationships between cocoa flavanols — the primary component in dark chocolate — multivitamins, and health outcomes, including effects on cognition. In 2023 and 2024, it connected the everyday multivitamin to advantages for cognitive aging and a decline in cognitive deterioration, with consistent results in three distinct placebo-controlled studies conducted in COSMOS.

Manson, akin to all health researchers, is attentively monitoring reductions in federal research financing. (A suspension of funding for the Women’s Health Initiative was reinstated following public outcry.) Her own funding has not been impacted; however, proposed cuts to indirect research costs would considerably affect her work, as studies like VITAL and COSMOS require substantial infrastructure and blood repository expenses. She’s troubled by cutbacks beyond her own division, given their wide repercussions on science and prevention nationally, as well as on training programs and pathways for future generations of scientists.

“It’s alarming what’s unfolding,” Manson expressed. “We’re clearly worried about our faculty and staff reliant on federal funding, but it truly extends beyond any particular division or research initiative. It represents a nationwide, and even global, effect on the scientific enterprise and public health.”