10 Survival Tips for Mr. Homo sapiens

Martin M Miner MDCo-Director Men’s Health Center

The Miriam Hospital Brown UniversityProvidence, RI

Men’s Health Program

April 9-11, 2010

L Vegas, NV

Life Expectancy

55606570758085

1930 1950 1970 1990 2005

Year

Year

s

menwomen

National Center for Health Statistics, 2008

Number of Men per 100 Women by Age

020406080

100

25 to

3435

to 44

45 to

5455

to 64

65

to 74

75 to

84 >85

Age

# of

Men

U.S. Census Bureau, 2000

Decreased Male Longevity: Impact on Women

• More than one-half of elderly widows living in poverty were not poor before the death of their husbands

• More than 20% of women who marry men their own age will be widows in their early retirement years (65-74)

• 80% of older people living alone are women

U.S. Administration on Aging

Comparison of Death Rates from Major Disease Groups

0

100

200

300

Heart disease

MalignancyAccidents

Chronic resp. ds

Deat

h ra

te p

er 1

00,0

00

menwomen

National Center for Health Statistics, 2008

Comparison of Death Rates from Major Disease Groups

0

20

40

60

Cerebrov

asc. d

sDiab

etes

Influenza

/ pne

umSuic

ide

Liver

ds / c

irrhos

is HIV

Deat

h ra

te p

er 1

00,0

00

menwomen

National Center for Health Statistics, 2008

Death rates for Heart Disease

0

500

1000

1500

2000

35-44 45-54 55-64 65-74 75-84Age

Dea

ths

per

100,

000

menwomen

National Center for Health Statistics, 2008

Death rates for Malignant Neoplasms

0

500

1000

1500

35-44 45-54 55-64 65-74 75-84Age

Dea

ths

per

100,

000

menwomen

National Center for Health Statistics, 2008

Comparison of Incidence Rates for Major Malignancies

0

20

40

60

80

Lung

/ bro

nch.

Colon &

rectu

mBlad

der

N.H. ly

mphom

aLe

ukem

iaOral

-phary

nxPanc

reas

Stomac

h

# of

new

cas

es

per

100,

000

menwomen

National Center for Health Statistics, 2008

Lifetime Probability of Developing an

Invasive Cancer:

Men: 1 in 2Women: 1 in 3

Cancer Statistics, 2009

American Cancer Society

2009 Estimated US Cancer Deaths

Source: American Cancer Society, 2009.

Men292,540

Lung & bronchus 30%

Prostate 9%

Colon & rectum 9%

Pancreas 6%

Leukemia 4%

Liver & intrahepatic 4%bile duct

Esophagus 4%

Urinary bladder 3%

Non-Hodgkin 3%

lymphoma

Kidney & renal pelvis 3%

All other sites 25%

Colon Cancer Screening

*WHEN?Ø Family History:

Age 50 (45 AA)

+ Family History:Age 40 or 10 yrs before diagnosis of 1st degree relative

*ACG Guidelines 2008

1. Don’t become a preventable statistic

Source: American Cancer Society, 2009.

Men292,540

Lung & bronchus 30%

Prostate 9%

Colon & rectum 9%

Pancreas 6%

Leukemia 4%

Liver & intrahepatic 4%bile duct

Esophagus 4%

Urinary bladder 3%

Non-Hodgkin 3%

lymphoma

Kidney & renal pelvis 3%

All other sites 25%

Get Scoped!!

Prostate CancerScreening

The Scoop on PSA Screening

2 Recent large studies:• US (PLCO): no ↓ mortality• EU (ERSPC): 20% ↓ mortality

– To prevent one prostate cancer death, 1400 men need to be screened and 48 men treated.

• Problem: PSA test does lead to earlier diagnosis of CAP but does not distinguish between lifethreatening vs. non-lifethreatening disease

CAP Screening Recommendations

• USPSTF– The current evidence is insufficient to assess the balance of

benefits and harms of prostate cancer screening in men younger than age 75 years

– Recommends against screening for prostate cancer in men age 75 years or older

• ACS– Discuss the option of PSA screening starting at age 50; earlier

if high risk (+ F.H. or African American)– Use of Informed-Decision Makign

• AUA – Offer DRE & PSA to well-informed men starting at age 40

Prevention of Prostate Cancer: Nutrition

• Flaxseed (3 tbs /day)• Low saturated fat diet • Omega 3 fatty acids• Exercise / weight control• Fruit & veggies (tomatoes,

pomegranate juice, broccoli, cauliflower)

• Whole grains / fiber• Soy (tofu) • Limit calcium to < 1200mg /day• Green tea (anti-inflammatory)

Prostate Healthy = Heart HealthyPhallus Healthy

Melanoma Screening

Testicular Cancer Screening

Occupational Deaths

Occupational Deaths by Gender

02

46

8

2000

2001

2002

2003

2004

2005

Year

Dea

ths

per

100,

000

menwomen

National Center for Health Statistics, 2008

Comparison of Male & Female Suicide Rates

0

10

20

30

40

50

20-24

25-34

35-44

45-54

55-64

65-74

75-84

85+

Age

Dea

ths

per 1

00,0

00

menwomen

National Center for Health Statistics, 2008

2. Get out of your cave and build and strengthen friendships

The Demise of Mr. Homo sapiens

Why?

•Unhealthy Behavior

Cigarette Smoking by Gender

0

10

20

30

18-24 25-34 35-44 45-64 >65Age

% o

f per

sons

malefemale

National Center for Health Statistics, 2008

2009 Estimated US Cancer Deaths

Source: American Cancer Society, 2009.

Men292,540

Lung & bronchus 30%

Prostate 9%

Colon & rectum 9%

Pancreas 6%

Leukemia 4%

Liver & intrahepatic 4%bile duct

Esophagus 4%

Urinary bladder 3%

Non-Hodgkin 3%

lymphoma

Kidney & renal pelvis 3%

All other sites 25%

3. Avoid tobacco like the plague

Alcohol Abuse

• Men more likely to develop alcohol dependence than women

• Men have more alcohol related problems than women

• Men have more aggressive behavior associated with excessive drinking than women

Clin Psychol Rev. Dec 2004

4. If you drink, set a limit of 1-2 drinks/day

Equivalent Amounts of Alcohol

(1 drink = ½ oz. of ethyl alcohol)

Motor Vehicle Accidents

Motor Vehicle-Related Death Rates

0

10

20

30

40

25-34 35-44 45-54 55-64 65+

Age

Dea

ths

per

100,

000

menwomen

National Center for Health Statistics, 2008

5. Make your drive the most important part of your day

Risk Taking Behavior

6. Avoid risk taking behavior

Male Bonding

Homer Simpson Syndrome Metabolic Syndrome*

• Abdominal obesity (waist ≥ 37 in)PLUS 2 of following:

• Elevated sugar (FBS > 100)• Elevated triglycerides ( ≥ 150)• Low HDL ( <40)• Elevated BP ( ≥ 130/85)

*International Diabetes Foundation

Diabetes

CoronaryArteryHeart Disease

Stroke

Metabolic Syndrome

47 millionAmericans!

JAMA 2002; 287:356-359

Exercise: The Miracle Drug

• Prevents Heart Disease

• Prevents Stroke

• Lowers Blood Pressure

• Improves Cholesterol Levels

• Prevents Obesity

• Lowers Stress Levels

• Improves Brain Function & Memory

• Reduces Symptoms of Depression & Improves Mood

• Helps Prevent Osteoporosis

7. Exercise for at least 30 minutes on the days you eat.

If you don’t find time to exercise, you’ll have to find time for illness.

The secret behind obesity: Portion Distortion

20 Years Ago Today

1,025 calories2 cups of pasta with sauce &3 large meatballs

Calorie Difference: 525 Calories National Heart, Lung, and Blood Institute

http://hp2010.nhlbihin.net/portion

500 calories1 cup spaghetti with sauce & 3 small meatballs

Percent of Obesity (BMI > 30) in U.S. Adults1985

No Data <10% 10%–14%

Percent of Obesity (BMI > 30) in U.S. Adults1989

No Data <10% 10%–14%

Percent of Obesity (BMI > 30) in U.S. Adults1993

No Data <10% 10%–14% 15%–19%

Percent of Obesity (BMI > 30) in U.S. Adults1995

No Data <10% 10%–14% 15%–19%

Percent of Obesity (BMI > 30) in U.S. Adults2001

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Percent of Obesity (BMI > 30) in U.S. Adults2005

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Percent of Obesity (BMI > 30) in U.S. Adults2007

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Waist circumference (WC)

• Belly fat is a strong predictor of cardiovascular disease

• WC inches (cm)<35 (89) Normal35-39 (89-100) Overweight≥ 40 (>101) Obese

8. Eat right and avoid portion distortion

730 calories + 45 grams of fat =$2.99

Cardiac catheterization = $2,300

Unhealthy Products and Advertisement Directed at Males

Baddest Burger: Hardee's Monster Thickburger

• Resume:1,410 calories47 grams carbs, 107 grams fat, 229 mg cholesterol, 2,740 mg sodium

(Hold the veggies!)

The Demise of Mr. Homo sapiens

Why?

• Unhealthy Behavior• Avoidance of Healthcare

Masculine Virtues

• Strength• Stoicism• Autonomy• Aggression• “Suck it up”

“I’m fine!”

Visits to Physicians Offices

0

200

400

600

800

18-44 45-54 55-64 65-74 75+

Age

Num

ber

of V

isits

per

100

Pers

ons

menwomen

National Center for Health Statistics, 2008

You can feel great but have killer numbers!

• LDL• HDL• Triglycerides• Fasting blood sugar• Blood Pressure• Waist circumference• PSA

Coronary Atherosclerosis

9. Know your # s!

ED is a strong predictor of cardiovascular disease in men < 60

• ED associated with a 50 fold increase in the 10 year incidence of a cardiac event in men!!

Penile artery: 1-2mmCoronary artery: 3-4 mm

Copyright ©2004 American Heart Association

Fields, L. E. et al. Hypertension 2004;43:e28

Risk of stroke mortality doubles per 20 mm Hg increase in systolic blood pressure (SBP)

Hypertension: The Silent Killer

Blood Pressure Classification

BPClassification

SBP(mm HG)

DBP(mm HG)

Normal <120 and <80Prehypertension 120-139 or 80-89

Stage 1 hypertension 140-159 or 90-99

Stage 2 hypertension ≥160 or ≥100

National Heart, Lung, and Blood Institute. JNC 7 Express. The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure. 2003.

The Demise of Mr. Homo sapiens

Why?

Unhealthy Behavior+

Avoidance of Healthcare

Premature Death & Disability

10. Give yourself 20 minutes a day to sit in the sun and be a turtle, read, listen to

music, or whatever hobby you enjoy

10 Survival Tips for Mr. Homo sapiens

10 Survival Tips for Mr. Homo sapiens1) Don’t become a preventable statistic 2) Get out of your cave and build and strengthen friendships3) Avoid tobacco like the plague4) If you drink, set a limit of 1-2x/day 5) Make your driving the most important part of your day6) Avoid risk taking behavior 7) Exercise for at least 30 minutes on the days you eat 8) Eat right and avoid portion distortion

• The lean man wins9) Go to the doctor regularly for a check up

• Know your numbers 10) Take 20 minutes a day to read, listen to music, or whatever

hobby you enjoy

Sleep Deprivation

• 63 million American adults are sleep deprived.

• A person who goes for 2 weeks with 6 hours of sleep is as cognitively impaired as someone who’s legally drunk

• 100,000 traffic accidents caused by drivers falling asleep claim1,500 lives each year

• Increased risk for HTN, heart attacks, stroke, diabetes, obesity

• Reduced immunity to infection

• Reduced productivity and ability to concentrate and remember

11. Get 7-8 hours of sleep per night

A Woman’s Touch

"Marriage, at least for males, has a huge benefit on health, and that being married is associated with men being more health proactive and practicing good health habits, such as seeing the doctor regularly for check-ups.”

Markey, New Jersey Family Health Survey, 2005

The Gretchen S. and Edward A. Fish Center for Women’s Health

Lord, help me to be the person my dog thinks I am.

Men’s Health

Stay Tuned………….