According to the Centers for Disease Control, the average American life expectancy declined to 76.4 years in 2021, reaching the lowest level since 1996. This statistic turned into a running joke in my family since most met the Grim Reaper before their seventieth birthdays. Lung cancer robbed my pack-a-day smoker grandmother of a long life at fifty-eight while her husband, at sixty-nine, succumbed to a heart attack a mere month later. My aunt’s sixty-year-old heart stopped, while her diabetic brother died from cardiac arrest at sixty-two. My mother, Jean, stubbornly resisted the numbers despite a long list of ailments, including two strokes, to celebrate her seventy-first birthday before dying of a severe cardiac event.

Physician Peter Attia, with co-author Bill Gifford, explores this concept of escaping the “aging apocalypse” in his New York Times bestseller, Outlive: The Science and Art of Longevity. Attia discusses diseases and illnesses, or what he dubs the “The Four Horsemen”—cardiovascular diseases, cancer, diabetes, and neurodegenerative diseases—that stampede throughout our lives, chasing us until our inevitable deaths. The end terrifies those racing against the clock, and escape from the four horsemen appears unavoidable.

Yet, the book asks the inevitable question: Can humans outrun the odds? My brother John and I have inherited Jean’s genes but hit the pavement to stay out of hospitals and nursing homes by collecting marathons and half-marathons under our worn-out shoes. My uncle Rick, sixty-nine, who underwent sextuple coronary bypass surgery, liked to tease us with the reminder that when we hit the big fifty, it would mean “the check engine light goes on.” My brother’s light blinked a warning right at forty-nine. Prostate cancer. Fixable. We ran a half-marathon together a year later. Still, my brother passed out on my shoulder from dehydration once finished, ironically after listening to “Till I Collapse” by Eminem to pump himself up before the race. Alarm bells, though, reminded us old age rounded the next corner of our lives. The fifty-year mark approaches next year for me, and I wonder if escaping our lifestyles, ages, or genes seems possible. Is it too late to change the cards dealt to us?

Attia mentions on his website that “as long as you’re breathing, you have a chance to do something about it.” Attia, known for his motivational medical podcasts, spins science with anecdotes to simplify research to layman’s terms in his nonfiction book. Someone shattering eggs against the pavement metaphorically drives the point home in the introduction. People, no matter their age, should dash up the stairs to care for those delicate shells before that happens. Eventually, the eggs will fall, but slowing down the momentum means paddleboarding on the ocean in those golden years rather than surfing the sofa, unable to move due to disease and disuse. Attia writes that we need “to figure out how to get to the top of the building, find the guy, and take him out.” The visionary author breaks the content into three parts: information on the different types of medicine, a description of the four horsemen, and tactical strategies to put practice into action. Well-thought research and data combined with real-world guidance color the pages to change how people think about the healthcare system. The author explains the history behind its stages, showing medicine needs to intervene before issues appear. Hippocrates laid the groundwork for “Medicine 1.0” for decades, much of it relying on now laughable conjecture like wandering wombs to explain hysteria rather than hard-core science. “Medicine 2.0” focuses on treating the acute symptoms after a diagnosis. Attia dubs “Medicine 3.0” the central theme, hoping to prevent or delay chronic diseases before treatment intercedes.

Unlike authors of other books touting magical cures, Attia pulls no punches and wants his patients or those reading to take action on their health now rather than waiting. Individuals must attempt to modify their lives before struggling to walk upstairs or lift their grandchildren in their later years. Dan Buettner discusses the same concept, in a sense, of achieving the goal of living longer by studying the blue zones—places where centenarians (a rare breed that reaches or exceeds one hundred years old) live, work, and play—in his best-selling novel turned Netflix documentary The Blue Zones Secrets for Living Longer: Lessons from the Healthiest Places on Earth. The series explores how silver-haired, wrinkled men and women defied the odds. Attia mentions centenarians in his book, referring to those who smoked, drank, and ate a dangerous path into old age. Attia, though, focuses on healthspan while Buettner focuses on lifespan.

Although genetics play a part in how long someone lives, the quality of those years matters more in the larger schematic. Attia bluntly describes healthspan in his PBS interview as “you are alive, or you are not alive.”  Even though Attia recommends biometric tests to check the engine before it fails, the answers don’t rely solely on expensive medical procedures. Even throwing on some sneakers increases the odds because “exercise is by far the most potent longevity ‘drug’” that delays Alzheimer’s, keeps the heart healthy, and decreases cancer risk. Some would rather wait until receiving a diagnosis such as high cholesterol before avoiding a greasy cheeseburger instead of protecting the arteries with spinach and salmon. Attia understands healthy commitment struggles and adds narrative touches about his struggles with gaining that mid-age weight and the possible fallout on his heart health. Plus, physical health relates to mental health, something Attia hones in on in the final chapters.

The book connects the dots, especially for someone approaching fifty years of age like myself, that time ticks faster with age. Even now, the strength in my muscles loosens, the webs form fogginess in my brain, and the fat clogs my arteries from youthful indulgences. Although the book feels like a realistic horror movie, the book illustrates that each individual drives and fuels the cars of their bodies. And maybe . . . just maybe . . . taking the wheel will give a healthier person a chance to delay the horsemen.