Just four diseases make up the list of common threats to men’s health. Learn how you can diagnose and prevent some of these troubles before they happen.
The list of the top health threats to men is surprisingly short. Just four diseases make up the list developed by the national Centers for Disease Control and Prevention (CDC): heart disease, cancer, chronic obstructive pulmonary disease (COPD) and stroke.
The good news is that, with sensible judgment and modern medical advancements, men not only can avoid or postpone these killers, but also survive them.
It’s no surprise that heart disease is at the top of the CDC’s list. After all, the CDC reports that men suffer 70 to 89 percent of sudden cardiac events, and one in every four dies from heart disease.
These grim statistics may be related to America’s aging population, but aging is not the only cause, says Dr. Maciej K. Malinski, a board-certified interventional cardiologist at Advocate Sherman Hospital in Elgin who is fellowship-trained in preventative cardiac medicine. In order to better diagnose heart disease before an emergency, physicians also try to pinpoint who’s most at risk, and when.
“There are multiple statistical calculators,” says Malinski. “The Framingham Risk or Reynolds Risk scores predict the possibility of developing heart disease. One can calculate a risk of having heart problems by pinpointing a person’s demographics and applying clinical information such as cholesterol levels, diabetes, hypertension and family history of premature heart disease. Traditionally, any case of heart disease in a male under age 50 is considered premature. At ages 50 to 55, we start to see it as a ‘natural’ consequence of aging.”
Because people are living longer, these traditional milestones have become a moving target.
“Patients close to age 80, in excellent health, who begin having heart problems, can undergo extensive cardiovascular procedures, recover and continue to live a fully functional life,” Malinski says. “Because of that perspective, doctors find it difficult to see a man with heart problems in his late 60s and think of it as something that is expected and natural.”
Age is one of the risk factors for developing heart problems, but high cholesterol and high blood pressure also contribute to vascular diseases such as kidney disease or peripheral artery disease (PAD) in the legs. So do unhealthy habits such as smoking, poor diet, obesity and lack of physical activity.
Awareness of heart disease is increasing, as are the signs of an impending cardiac emergency. Swift intervention, preferably in the first hour of the onset of heart attack symptoms, has significantly reduced the number of deaths, says Malinski. So, too, has stenting to open blocked arteries, diagnosing and controlling atrial fibrillation, and recognizing and treating earlier valvular disease and risk factors.
“The positive impact of coming in earlier, when damage to the heart muscle can be limited, has proven to be life-saving,” Malinski says. “Beyond that, these patients experience improved function and live long enough that they often die years later as the result of another disease.”
Recovery from a cardiac emergency requires a change in lifestyle that prioritizes treating hypertension and high cholesterol, while adjusting diet and daily exercise routines – adjustments with which men often struggle.
“Men, for many reasons, do not do well with taking medications,” Malinski says. “Frequently, I see male patients a few years after a heart attack not taking medication. That’s why treating chronic cardiovascular conditions in men is sometimes challenging. I usually have to explain to them again that opening a heart artery with a stent is not a cure for the disease, but rather a fix of an acute problem.”
Lung cancer is currently the leading cause of cancer death for both men and women, but the rates of death from prostate cancer are also staggering, says Dr. Courtney Coke, radiation oncologist and medical director of the Bob and Edna Meadows Regional Cancer Care Center at Presence Saint Joseph Hospital in Elgin. According to this hospital, about 22 in 100,000 men will die of prostate cancer.
“Based on autopsy studies of males at the age of 90, there is a 95 percent chance that an element of prostate cancer will be found,” says Coke. “The good news is that only one in six will develop a clinically significant prostate cancer. Overwhelmingly, the majority will live with prostate cancer and never know it. The challenge is to know which cancer will require treatment.”
Thanks to more aggressive testing, death rates for those with prostate cancer has diminished significantly, Coke says. He recommends that men over age 50 receive a yearly PSA blood test, in addition to an annual physical for those with a family history of prostate cancer or of particular ethnicities that are more at risk. When a man is diagnosed with prostate cancer, many factors will determine his individual course of treatment.
“Generally, surgical removal of the prostate is recommended for men 55 and under,” Coke says. “The advantage of this approach is that 30 percent of the time, we learn additional information not found from biopsies alone.”
However, other treatment options may exist for patients who have low-risk prognostic factors, and whose cancer is in the early stages or has a limited volume, says Coke. The brachytherapy implant is one such option, and it involves placing radioactive seeds in the prostate.
“The implant procedure is performed jointly by the radiation oncologist and the urologist,” Coke says. “Prior to the procedure, an ultrasound is used to examine the prostate and the surrounding tissues, so that we can determine how many seeds to implant.”
During the procedure, the patient is placed under general anesthesia. Using an ultrasound, the surgical team positions the radioactive seeds only in the prostate, sparing adjacent tissue. The outpatient procedure takes between 45 minutes and an hour.
Potential complications can occur at a higher rate with brachytherapy implants, Coke says. Prostatectomy patients, however, are more likely to experience incontinence or urine leakage. Success rates in either case are about the same, Coke says. When factors suggest a more aggressive tumor, combinations of external beam radiation, hormone treatment and brachytherapy implant have better outcomes.
“If a patient chooses surgery and there’s evidence that a microscopic tumor remains, then external beam radiation can be used as an additional treatment with high success of cancer control,” Coke explains.
When patients are 56 to 60 years old, treatment is often determined by the aggressiveness and extent of the tumor. For those beyond 60, doctors tend to recommend radiation, although surgery may still be considered. Past 70, radiation is the treatment of choice, says Coke.
After heart disease and cancer, chronic obstructive pulmonary disease (COPD) is the most common cause of death in men. Sadly, COPD is almost entirely preventable. Smoking is the primary cause, but Dr. Satish Gowda, a board-certified pulmonary critical care and sleep specialist at Advocate Good Shepherd Hospital in Barrington, says other factors significantly figure in COPD cases.
“Inadequate or improper ventilation can result in COPD over time,” Gowda adds. “So, too, does air pollution and extremely poor air quality. The environment also plays a role in COPD cases, especially in Third World countries.”
The lungs are the only major organ, besides skin, that comes into direct contact with outside air. Carbon monoxide and airborne particles seep into the lungs and, over time, destroy the airways by creating oxygen free radicals and various other mechanisms.
“When the lungs lose elasticity because of this corrosive environment or smoking, they can no longer stretch and relax like an elastic band,” Gowda says. “Airways can also thicken from inflammation, resulting in chronic bronchitis, leaving patients struggling to breathe.”
Chronic bronchitis and emphysema are the two spectrum diseases associated with COPD, either separately or in combination. Patients experience shortness of breath or difficulty breathing, and are susceptible to wheezing or coughing, sometimes dry and other times with mucous that persists for months.
“A patient may come in complaining of these symptoms,” Gowda explains. “His primary care physician may start off with a patient history, physical examinations, chest x-ray examinations, arterial blood gas analysis and tests of pulmonary function. When COPD is suspected, a pulmonary function test (PFT) helps to evaluate the severity of COPD.”
The PFT measures how well patients are able to move air in and out of the lungs. During the test, a patient inhales into the PFT equipment as deeply as possible, to fill his lungs, then breathes out as quickly as possible, for six seconds.
“The results are quantified and grouped into different severity by what we call the GOLD criteria formulated by the Global Initiative for Chronic Obstructive Lung Disease,” Gowda says. “A numerical score for FEV1 (amount of air you breathe out in first second during PFT) greater than 80 percent predicted indicates a mild COPD, while a score of 79 to 50 percent means the patient has a moderate severity. For those falling in the 30 to 49 percent predicted value, the COPD is severe. Anything below 29 percent is very severe.”
Mild COPD can be successfully treated with bronchial inhalers and carefully chosen medications. Gowda says these can be used as needed, but when the COPD is moderate or severe, the treatment must be daily.
“This is based on standard maintenance therapy programs,” Gowda says. “But when we see the sudden onset of more severe symptoms, we suspect infections such as pneumonia or bronchitis, or accidental chemical inhalation, or even overexertion.”
When the symptoms are truly severe, Gowda says, steroid treatment may be necessary, sometimes supplemented with antibiotics. COPD is an incurable progressive disease that may eventually require the use of personal oxygen therapy.
“Stopping smoking is the best way to prevent COPD, although once a man has this disease, he will still have it even if he quits,” Gowda says. “How and when a man contacts COPD depends on how early in life he started smoking and how long it has gone on. We really don’t have an age bracket for COPD, but through experience, we see the beginnings in men who have smoked around a pack a day for five years.”
Once diagnosed, men should have regular physical exams, keep their immunizations up-to-date, and avoid exposure to pollution and sick people.
“One fact most people don’t know is that, after the age of 20, we all begin to lose lung function,” Gowda says. “If men smoke or are exposed to adverse environmental conditions such as working in mines or other hazardous occupations, they lose more lung function compared to those who aren’t exposed.”
The risk of stroke increases with age, says Dr. Sailaja Maramreddy, who is board-certified in vascular neurology at Northwest Community Hospital in Arlington Heights.
“Studies have shown that, after the age of 55, the risk of stroke doubles with every decade of a person’s age,” Maramreddy says. “Risk of stroke is also higher in men than in women of the same age.”
Major risk factors include age, race, gender and family history of stroke, as well as PAD and COPD, which increase the risk of plaque buildup in carotid arteries.
“Treating medical conditions such as hypertension, diabetes, nonoptimal cholesterol LDL/HDL ration, heart disease (coronary artery disease, valve defects, atrial fibrillation) can reduce the risks,” Maramreddy says. “Atrial fibrillation is a common factor of stroke in older adults. Other lifestyle factors include smoking and physical inactivity.”
In fact, those same risk factors, in addition to diabetes and dyslipidemia (a metabolic imbalance related to cholesterol levels), may also indicate the probability of a stroke and its severity.
In the event that a stroke occurs, early detection and intervention play a strong role in a patient’s survival.
“If there are no exclusion criteria, within three hours and, in some cases, up to four-and-a-half hours of onset of symptoms, stroke sufferers can be treated with intravenous medicine, which helps to improve recovery,” Maramreddy says. “There is also another option, endovascular clot extraction, performed by endovascular neurointensivists, if the patient has developed a clot in larger blood vessels. But there are certain time frames and criteria involved to determine if the patient is able to undergo these treatments.”
Recovery after a stroke depends on several factors, including the type of stroke (ischemic or hemorrhagic), location of the brain damage, and the size of the stroke, Maramreddy says.
“It also depends on how soon the person is treated after a stroke,” she adds. “It’s important to remember that recovery is gradual, and at times, damaged parts of the brain cannot recover.”
The surgical procedure of revascularization is sometimes used to open up the diseased arteries, to improve the blood flow to the brain and to reduce the risk of future strokes.
During the recovery process, exercise is essential. Stroke increases the risk of blood clot formation in the veins of extremities, says Maramreddy, and this risk increases with sedentary lifestyles.
Thankfully, some of the risk factors of stroke are within a man’s control.
“Male patients need to modify contributing lifestyle factors by quitting smoking, eating healthy and exercising,” says Maramreddy. “Sixty percent of strokes are attributed to risk factors that can be reduced or eliminated.”
Men are faced with many health threats, but with the right combination of proactive steps, these conditions are largely preventable. Regular checkups, healthy lifestyles, and awareness of disease symptoms are all essential starting points.