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When president-elect Donald Trump is sworn in for a second term he will become the oldest president ever inaugurated -- raising questions as to whether the 78-year-old is at risk of a major health event while in office.

S. Jay Olshansky, PhD, of the University of Illinois Chicago, and colleagues previously wrote a assessing the health of both Trump and President Biden, but Olshansky cautioned that there are more unknowns this time around.

"We have reviewed his medical records before, and he does have some risk factors for certain diseases -- cardiovascular disease and Alzheimer's -- but we haven't seen his records in the last 4 years, so we don't really know if anything has changed," Olshansky told MedPage Today.

At the time of the 2020 report, Trump was taking rosuvastatin (Crestor) for cholesterol, aspirin for cardiac health, finasteride (Propecia) for hair loss prevention, ivermectin cream for rosacea, as well as a multivitamin, though it's unknown if he takes the same drugs today. Trump also had COVID in October 2020.

In general, Trump has a 79% likelihood of living through this 4-year term based on the average life expectancy of an American man of his age, Olshansky said. (Biden was also 78 at the time of his inauguration in 2020, but Trump will be 5 months older than Biden was at the time.)

Trump may have some advantages that will put him above that average, said John Rowe, MD, professor of health policy and aging at Columbia University.

"If you want to live a long time and you're a 78- or 79-year-old male, what you want to do is to be well off financially, have significant educational attainment, which means college or more, be married or have a live-in partner, and not smoke," Rowe said, noting Trump has all of those things.

Otherwise, Rowe said the first question he asks male patients around Trump's age is how many times in the past week they have interacted with friends or family.

"Social engagement is the most important variable and isolation is toxic," he noted, adding that as president, Trump will have one of the most socially connected jobs in the world.

Trump's former White House physician Rep. Ronny Jackson, MD (R-Texas), has previously said that Trump also enjoys health benefits from a lifetime without drinking or smoking.

In terms of job stress, Olshansky published in 2011 that found that American presidents live longer than average, and that all living presidents "have either already exceeded the estimated life span of all U.S. men at their age of inauguration or are likely to do so." Indeed, former President Jimmy Carter, the oldest living president, recently celebrated his .

"Stress may accelerate the graying of hair and wrinkling of skin, but we don't die from gray hair and wrinkled skin. So I'm not all that concerned about that," Olshansky said.

Finally, it's generally rare for presidents to die due to health conditions while in office. In the past century, only two presidents died from disease: Warren Harding in 1923 from myocardial infarction, and Franklin D. Roosevelt in 1945 from a massive cerebral hemorrhage.

While Trump "has very favorable social determinants of health -- higher education, higher income, access to the best medical care in the world" and thus has "a lot going in his favor," he does have some disadvantages, Olshansky said.

For instance, Trump's current body mass index isn't known; nor is his coronary calcium score, which can indicate heart disease risk. Previously, his coronary calcium score was "very high," Olshansky said, and his diet is "not so favorable."

And Jackson previously said Trump "would benefit from a diet that is lower in fat and carbohydrates, and from a routine exercise regimen."

Other factors that could impact health and longevity -- like trauma from multiple assassination attempts -- are harder to quantify. Jackson issued the only memo about Trump's injuries from the first assassination attempt and he did not experience post-traumatic stress disorder or other residual health effects.

Trump has received criticism, including from doctors, for not releasing his medical records during this election season. As of November 2023, his personal physician has said Trump was in "excellent" health with "exceptional" results on cognitive exams.

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