Top Health Risks Affecting Men

by DEBBE GEIGER, Duke Medicine News Office
September 2009

Heart disease, stroke, cancer, diabetes and mental health are the top five health issues that can strike men, sometimes without warning, starting in the prime of their life. Fortunately, new research is making it possible to diagnose these diseases early and manage them once they occur.

Heart Disease — Heart disease is responsible for more than 300,000 male deaths each year, according to the Centers for Disease Control. Most men who die from heart disease are under the age of 65.

You’re at risk if you have high blood pressure, high blood cholesterol, diabetes, use tobacco, live a sedentary lifestyle and don’t follow a healthy diet.

Knowing the signs and symptoms of a heart attack is also crucial. If you experience severe chest pain, shortness of breath, fainting and nausea, get help immediately.

Problems can still arise because heart attack symptoms aren’t always easy to recognize. In fact, "silent" heart attacks now appear to be more common than previously believed, according to researchers at Duke University Medical Center in Durham.

The Duke cardiologists say up to 200,000 people in the U.S suffer a heart attack each year but may not realize it because they don’t cause any pain — or at least any pain that patients believe is related to their heart — and they may not leave behind any telltale irregularities on electrocardiograms (ECGs).

Duke cardiologists found these heart attacks (technically referred to as unrecognized myocardial infarctions, or UMIs) may be happening much more frequently than physicians had suspected. They also reported these attacks were associated with a surprisingly high risk of untimely death.

Armed with that knowledge, Han Kim, MD, a Duke cardiologist says they’re now working to figure out how common silent heart attacks are in the general population (not just those at risk for heart disease). Then, he says, "we can determine whether early screening and treatment of these patients helps avoid deaths."

Stroke — Stroke Strokes, the third-leading killer of men, occur when an artery carrying oxygen-rich blood to the brain is blocked, causing injury to brain cells, or when a blood vessel bursts, causing blood to push on brain structures. In either case, the resulting damage can lead to permanent disability and sometimes death.

Most stroke victims don’t die, but they don’t fully recover either. Stroke is a leading cause of long-term disability in the U.S. About 4.4 million Americans live with stroke-related disabilities.

The most important way to minimize the damage of stroke is to recognize the symptoms and know what to do when they occur, says Larry B. Goldstein, MD, a neurologist and director of the Duke Stroke Center. Call 911 immediately if someone is experiencing the sudden onset of any of the following symptoms — known as the Give Me 5:

Walk: Sudden trouble walking, dizziness, loss of balance or coordination
Talk: Sudden trouble speaking or understanding
Reach: Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
See: Sudden trouble seeing in one or both eyes
Feel: Sudden severe headache with no known cause

Up to 11 million Americans suffer silent strokes each year. They don’t cause any symptoms, but can start the process of damaging your ability to function. "By definition, you don’t even know it happened," says Goldstein, "but you may find your balance isn’t the same, you become more forgetful, and you can’t make your body move the way it used to."

Stroke risk increases with age. African Americans and Hispanics are at higher risk of stroke than Caucasians. If you have a parent, brother or sister who had a stroke under age 65 , you’re at increased risk.

Those factors can’t be controlled, but following a healthy diet, staying active, not smoking, limiting alcohol consumption and maintaining a lean weight can lower your risk of developing a stroke. Managing your blood pressure, being treated for an irregular heart beat called atrial fibrillation and other medical treatments can also minimize you risk. Reducing stress may also be helpful.

Lung Cancer — Lung cancer, the leading cause of death among men, says the American Cancer Society is an aggressive disease that spreads quickly. In many cases, it’s too late to treat by the time it’s diagnosed. Studies show less than half of men are still alive one year after lung cancer is detected.

Hope is on the horizon at Duke. Doctors are using genetic studies to better understand rare pulmonary cancers, and to develop drug strategies based on genetic alterations in the tumor cells. They are identifying new ways to personalize chemotherapy treatment based on the tumors’ genetic expression. And, they are investigating new noninvasive diagnostic methods to help identify each person’s unique risk for cancer, and to identify tumors at an early stage.

Research also focuses on new drugs that stave off infection and hasten patient recovery after chemotherapy. At the same time, studies underway are aimed at improving quality of life issues, ranging from the effects of chemotherapy to managing pain, fatigue and breathing difficulties.

Since lung cancer is one of the most preventable types of cancer, there’s much you can do to minimize your risk, especially since the biggest culprit is smoking.

You can also lower lung cancer risk by reducing your exposure to cancer-causing substances like radon, asbestos, fumes, dust and chemicals.

Prostate Cancer — Prostate cancer is the most common type of cancer found in American men with nearly 200,000 new cases diagnosed each year, according to the National Prostate Cancer Coalition. Approximately 30,000 men die from the disease annually.

The prostate is a walnut-sized gland located behind the penis. It secretes fluids that are necessary for ejaculation, but may cause problems as men age. As a result, prostate cancer is most often found in men over the age of 60 though it is increasingly being found in younger men, says Stephen Freedland, MD, a urologist at Duke University Medical Center’s Prostate Center. Fortunately, medical advances in recent years mean that 85 percent of men with prostate cancer will survive.

Doctors are catching prostate cancer earlier with the use of annual screening for prostate specific antigen (PSA) which is recommended for men between the ages of 40 and 75, and a digital rectal exam, says Judd Moul, MD, chief of urology at Duke.

Once diagnosed, the latest advances in treatment run the gamut from medications, including include hormone therapy and chemotherapy, to procedures that treat the diseased prostate through surgery (both robotically and minimally invasive open surgery), radiation, cryotherapy, and high-intensity focused ultrasound waves. Moul says it’s important to work with your doctor to determine the treatment that’s right for you.

One exciting area of research is aimed at finding new ways to slow the growth of prostate tumors. Recently, Duke researchers reported that a low-carbohydrate diet may do just that. The research, which has only been conducted in mice so far, shows that a diet devoid of carbohydrates appears to lower insulin levels which may contribute to prostate cancer growth.

Alzheimer’s Disease — Alzheimer’s Disease is not a sign of normal aging as many people mistakenly believe. It’s a progressive and devastating deterioration of intellectual functions including memory, thinking and behavior that affects at least five million people in the U.S.

The prevalence of Alzheimer’s disease is predicted to quadruple world-wide by 2050 to more than 107 million cases, meaning that 1 in 85 persons will be living with the disease. It has been estimated that delaying disease onset by one or two years will decrease the disease burden in 2050 by 9.5 million or 23 million cases, respectively.

Recently, a team of Duke researchers, led by Allen Roses, MD, announced the identification of a gene that may not only predict a person’s risk of developing the disease, but also the approximate age of the disease’s onset.

In the past, Duke research has led to a better understanding of the risk factors that predispose a person to Alzheimer’s Disease. They now know a link exists between the disease and high cholesterol, high blood sugar, obesity and high blood pressure.

While there’s still no way to prevent Alzheimer’s, strengthening your brain may help prevent its onset. Here’s how, according to Morali Doraiswamy, MD, head of biological psychiatry at Duke and co-author of the Alzheimer’s Action Plan:

Do mental push ups. Studies show that working out your brain with crossword puzzles, playing chess or even learning a new language can boost production of nerve growth factors that maintain important cell connections.
Cross train it. Just like your body, your brain can get used to the same activity. Mix it up by learning a new skill, or attending a lecture on an unfamiliar topic. Use your left hand instead of your right.
Be a social butterfly. Enjoy social times with friends rather than suffer in solitude. And don’t skip on sleep. Chronic sleep deprivation has been shown to cause Alzheimer’s-like symptoms.
Feed your brain. Foods rich in omega-3 fatty acids, brightly colored fruits and vegetables are all filled with healthy nutrients that are as good for your brain as they are for your body.
Don’t stress. It’s the ultimate enemy of brain function. Do yoga, meditation and proactive mindfulness to keep your brain relaxed and happy.

Diabetes — A recent report found the incidence of diabetes has doubled in the past 30 years, and the biggest jump is in men.

According to Mark Feinglos, MD, an endocrinologist at Duke, diabetes occurs when the body can’t control the amount of sugar, or glucose, circulating in the blood. That occurs, either because the pancreas can’t produce enough of the hormone insulin to manage the sugar made from food or because cells in the body become resistant to insulin and can’t effectively use the sugar for energy. That often is the result of excessive weight gain, which makes cells in the muscles, liver and fat tissue less responsive to insulin.

Insulin works by stimulating cells to absorb glucose from the blood stream and use it for energy. When it isn’t produced, or the tissues become resistant, the level of sugar in the blood rises. Over time, high blood sugars cause damage to vital organs such as the eyes, kidneys, and nerves, and can eventually lead to heart disease, stroke, blindness, kidney disease, poor circulation and many other complications.

Today, about six million people in the US have diabetes and don’t know it. That’s because most symptoms go unnoticed until high sugars have already done their damage. That can be avoided by catching this chronic disease early. If you’re over age 45 and overweight, ask your doctor for a simple blood test which measures blood glucose levels. Look for symptoms such as increased thirst, increased hunger, frequent urination, especially at night, fatigue, blurred vision and sores that don’t heal which are all signs of high blood sugars.

A variety of medications are available to manage blood sugars, but the most important adjunct to treatment is daily exercise and a healthy diet.

A Healthy Lifestyle is Key to Prevention — Most of these conditions can be prevented, and their risk to your health minimized if you follow these recommendations for adapting a healthy lifestyle:

Avoid smoking, tobacco products and breathing in second-hand smoke. Likewise, reduce your exposure to any cancer-causing substances like air pollution, radon, radiation and asbestos.
Make sure the majority of your diet comprises vegetables, fruits, whole grains, fiber and lean protein like chicken and fish. Avoid foods saturated in fat and high in sodium. It’s also important stay away from foods containing sugar or highly refined carbohydrates like white flour.
Follow your doctor’s advice when it comes to getting regular check-ups, screenings, managing your high blood pressure, high cholesterol or high blood sugars.
Keep stress to a minimum.
Include regular physical activity in your life.
Maintain a healthy weight.
Drink alcohol in moderation.