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A presentation discussing selected preventative health topics for men across the life span. Semi-detailed discussion of coronary artery calcium screening.

A presentation discussing selected preventative health topics for men across the life span. Semi-detailed discussion of coronary artery calcium screening.

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Mens health Presentation Transcript

  • 1. Men’s Health Issues Frank W Meissner MD FACP FACC FCCP FASNC CPHIMS
  • 2. Life is What Happens To Us As We’re Making Other Plans Men 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
  • 3. 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
  • 4. 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
  • 5. 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)
  • 6. 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
  • 7. 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
  • 8. Counseling Topics for 50- 74 y/o Males Diet & Exercise - Abdominal Obesity Smoking, Alcohol, & Drugs Relationships & Sexual Health Aging Related Decrease in performance & Capacity Retirement & Change Management
  • 9. 4-747’s # Deaths/DDeaths(thousands) Coronary Heart Dz Cancer Accidents HIV/AIDS 959.2 544.7 93.8 32.7 American Heart Association. Heart and Stroke Statistical Update 2007.
  • 10. Paradigm Shift- CAD Detection Symptomatic Luminal Obstruction Asymptomatic Arterial Wall Atherosclerosis
  • 11. 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
  • 12. 20% 80% 80% Plaque Detectable by IVUS, Pathology Lipid Rich Fibrotic Calcified 20% 80% Total Coronary Plaque & EBCT Coronary Calcium
  • 13. Calcium Scoring Guidelines
  • 14. 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) 2=1363, p<0.0001 for variable overall and for each category subset. CumulativeSurvival 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
  • 15. 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.
  • 16. 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
  • 17. 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.