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.