Mens health
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Transcript of Mens health
Men’s Health Issues
Frank W Meissner MD FACP FACC FCCP FASNC CPHIMS
Life is What Happens To Us As
We’re Making Other PlansMen Live 5-6 yr Less than Women
Higher Mortality Rates all diseases < age 65
4X more likely to die - CVD
2X more likely to develop NIDDM
4X more likely to commit suicide
3X more likely to die in MVA
4X more likely to die accidentally
Aiding the Grim Reaper
Men More Likely Than Women to
Eat High Fat Foods
Exercise Less (after age 35)
Drink ETOH Excessively
Smoke & Use Recreational Drugs
Engage in Risk Taking Behavior
Less Likely to admit to experiencing stress
Ignorance isn’t Bliss, it’s Just Stupid
Men
Less Likely to have a GP
Less Likely to seek preventive health services
Less likely to undergo Psych Counselling
More likely to consider waiting for appointments a waste of time
Preventative Care 20-49 y/o Males
Blood Pressure Check
Blood Cholesterol Level Q 5yrs
FHx (melanoma, bowel cancer, prostate cancer, hyperlipidemia, AMI < 55 y/o, diabetes)
Skin eval (signs of UV damage or skin cancer)
Mental Health (Depression screening/Stress)
Immunization (Td booster, HepB, MMR)
Counseling Topics for 20-49 y/o Males
Diet & Exercise - Abdominal Obesity
Smoking, Alcohol, & Drugs
Relationships & Sexual Health
Occupational Health + Accidents/Risk Taking
Testicular Self Exam
Coronary Calcium Screening Q 5yr @ age 45
Preventative Care 50-74 y/o Males
All items for 20-49 y/o
Coronary Calcium Screening Q 5yr @ age 45
Prostate screening (annual rectal exam + PSA)
Diabetes screening - Urine Glucose - Blood if required
Glaucoma Eye Pressure Test
Counseling Topics for50- 74 y/o Males
Diet & Exercise - Abdominal Obesity
Smoking, Alcohol, & Drugs
Relationships & Sexual Health
Aging Related Decrease in performance & Capacity
Retirement & Change Management
4-747’s # Deaths/DDe
aths
(tho
usan
ds)
Coronary Heart Dz Cancer Accidents HIV/AIDS
959.2
544.7
93.832.7
American Heart Association. Heart and Stroke Statistical Update 2007.
Paradigm Shift- CAD Detection
Symptomatic Luminal Obstruction
Asymptomatic Arterial Wall Atherosclerosis
Texas Heart Attack Prevention Bill
Rick Perry signed into Law 19Jun09 - went into effect 1Sep09
Mandates Insurers to pay $200 Q5yrs
Measurement of Internal Carotid Media Thickness
Coronary Artery Calcification
Diabetics, Men ≥ 45 ≤75, Women ≥55 ≤75
20%
80%80%
PlaqueDetectableby IVUS,Pathology
Lipid Rich
Fibrotic
Calcified
20%
80%
Total Coronary Plaque & EBCT Coronary Calcium
Calcium Scoring Guidelines
Time to Follow-up (Years)
0 (n=11,044)
1-10 (n=3,567)
11-100 (n=5,032)
101-299 (n=2,616)
300-399 (n=561)
400-699 (n=955)
700-999 (n=514)
1,000+ (n=964)
χ2=1363, p<0.0001 for variable overall and for each category subset.
Cu
mu
lati
ve S
urv
ival
0.0 2.0 4.0 6.0 8.0 10.0 12.0
0.70
0.75
0.80
0.85
0.90
0.95
1.00
All Cause Mortality and CAC Scores:
Long Term Prognosis in 25, 253 patients
Budoff, et al. JACC 2007; 49: 1860-70
Taylor et al – PACC Study – JACC 2005
2000 patients, mean age 43
Coronary calcium demonstrated 11.8-fold increased risk for incident coronary heart disease (CHD) (p 0.002) in a Cox model controlling for the Framingham risk score.
In young, asymptomatic men, the presence of coronary artery calcification provides substantial, cost-effective, independent prognostic value in predicting incident CHD that is incremental to measured coronary risk factors.
Calcium Scoring Helps you individualize cardiac risk and since it is associated with an image that is easily understood by your patient’s it is a potent tool that facilitates lifestyle modification, improves medication compliance, establishes a risk baseline, allows for reassessment of risk, assessment of efficacy of preventative therapy, and helps to better target the health care dollars being spent on preventation.
Treat to Calcium Plaque stability (annualized incr in Ca++ Plaque < 15%) rather than LDL <70 mg/dl
AHA 2006
Cardiac CT improves risk prediction, especially in individuals determined to be at intermediate risk according to the NCEP ATP III criteria and for whom decisions concerning prevention strategies may be altered based on the test results.