Including our current president, only 43 individuals have served as President of the United States.  Of those, eight have died in office, a whopping 19% (would you take a job where you had roughly a one-in-five chance of dying?).  So maybe it’s important to clearly and deeply understand the health status of the two current candidates for the position of Commander in Chief (not to mention the health of the two men in running to fill those shoes should the president not survive his or her full term in office).

But wait…four of the eight who died while president were assassinated:  Abraham Lincoln (1865); James Garfield (1881); William McKinley (1901); and John F. Kennedy (1963).

Yet four presidents did (9%) die in office from medical conditions.  William Harrison succumbed to a lung infection (pneumonia) in 1841.  Today, approximately fifty-three thousand Americans die annually from pneumonia; however, most of these are individuals with other conditions that make them more susceptible to dying from pneumonia (such as COPD, diabetes, heart disease, immune system conditions, etc.).  And while pneumonia is most threatening to those at the ends of the age spectrum (the very young and the elderly), neither The Donald nor Hillary have any known significant risk factors to suggest that they would exit the Oval Office as did poor President Harrison.

Zachary Taylor, our twelfth president, died in 1850 from presumed infectious diarrhea.  Certainly a miserable way to pass, but of little in terms of life-threatening risk to today’s presidential contenders, or to you, unless you travel extensively or are immunocompromised.  That said, worldwide, diarrhea is the second leading cause of death for children under the age of five, killing just fewer than 2,200 little ones each and every day.  These poor youngsters routinely die not from the infectious agent itself, but from diarrhea-induced dehydration.

President Garfield is believed to have died in 1881 from a heart attack (myocardial infarction).  Now this is something that certainly threatens all of us, including our current presidential candidates.  Cardiac disease is the leading cause of mortality in both American men and women, causing one in four deaths (over six-hundred-thousand annually).  There are a number of risk factors for heart disease, including smoking, diabetes, obesity, inactivity, high blood pressure (hypertension), and elevated blood cholesterol.  Again, neither Trump nor Clinton appears to be at elevated risk of a heart attack relative to other seemingly healthy older Americans.

In 1945, Franklin Delano Roosevelt died following a stroke.  Similar to a heart attack, in which a blocked artery reduces or prevents blood flow to the heart itself, almost 90% of strokes result from limited or absence of blood flow to an area of the brain due to arterial blockage.  In the remaining stroke victims, blood flow is reduced when a blood vessel in the brain suddenly leaks (a hemorrhagic stroke).  Strokes account for about 5% of all U.S. deaths, killing close to 130,000 Americans annually (and close to 800,000 suffer but survive a stroke each year).  There are many risk factors for stroke, both medical and non-medical.  Ethnicity is critical, as African Americans, Hispanics, and Native Americans all are at greater risk of stroke than Caucasians.  And while strokes occur more frequently in men, women die more often.  Smoking, limited exercise, and obesity are behavioral risk factors.  And diabetes, high blood pressure (hypertension), elevated blood cholesterol, and heart disease also increase your risk.  But the most important risk factor for stroke?  Age.  Here, too, neither presidential candidate has any known risk factor other than their age.

So what is the real risk that if elected, President Trump or President Clinton would die in office?

Donald Trump turned 70 earlier this summer, which would make President Trump the oldest person to ever first occupy the Oval Office.  The recent release by Trump’s personal physician regarding his health status raised eyebrows for its non-traditional verbiage.  But objectively, overall Trump appears healthy.  He clearly is not morbidly obese.  His blood pressure is under control.  And he doesn’t smoke.  His widely reported limited sleep habits likely do indeed slightly suppress his immune system, but medically speaking, he has no striking medical risk factors other than his age (with the associate risk of stroke, heart disease, and cancer, a concern likely no greater than for any other reasonably healthy 70 year old).

Just weeks prior to the November election, Hillary Clinton will hit 69, which would mean that in addition to being our nation’s first female occupant of the White House, she would be the country’s second oldest president (Reagan was also 69 when first elected).  Recently, numerous interviews and articles have been published (including from physicians) questioning Clinton’s health, based especially on video images viewed suggesting to some a difficulty with balance, significant fatigue, and confusion.  Certainly confusion (and, arguably, fatigue) would be concerning in the leader of the free world; however, the evidence for these is circumstantial.  What is not circumstantial are the multiple reports from credible media sources that about four years ago, Secretary of State Clinton suffered a clot in one of the major veins draining blood from her brain.  Such “cerebral venous thrombosis” does not cause a stroke (which is caused by arterial blood flow problems to the brain), but the clot can increase the pressure inside the inflexible skull.  If not treated, such a major brain vein clot can lead to seizures, altered mental status, and even stroke-like loss of functions.  Clinton had no such reported symptoms and was treated with blood-thinner medications (anti-coagulants).  She developed the brain vein clot after falling and hitting her head.  (The fall also resulted in a concussion, with subsequent headaches and double-vision.)  Clinton’s fall and head trauma resulted from dehydration due to a stomach virus (perhaps we should worry about diarrhea, President Taylor’s killer).

So in the end, what do we have?  First of all, we must take these medical reports for what they are: very high level, and impacted by the celebrity/political reality of the two patients.  Thus, we do not have detailed information about either Trump’s nor Clinton’s family history, personal behavioral history, or past medical history.  So with that very large grain of salt (medically speaking), Donald Trump appears to be a healthy (albeit sleep-deprived) 70 year old; thus, he is projected to live another fourteen years (remember, life expectancy depends on to what age you have already survived).  And Hillary Clinton, soon-to-be 69, is projected to live until age 86.  Therefore, unless there’s a radical change in our Constitution, both could serve as President twice (presuming we wish to re-elect either to a second term).

Thus in the end, it is probably unreasonable to use either of what we know of our two candidates’ current health status as justification for voting for one over the other.  But I didn’t really write this column to make you think about Donald Trump’s health, weight, smoking, blood pressure, or risky habits.  Or Hillary Clinton’s.

I wanted you to think about you.

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