Men’s health month: How to prevent, diagnose, treat CVD in men
June is Men’s Health Month, a time intended “to heighten the awareness of preventable health problems and encourage early detection and treatment of disease among men and boys,” according to Men’sHealthMonth.org.
Throughout the month, Healio Family Medicine will highlight health conditions and their impact on men. Our coverage will include discussions with experts on how to prevent these health conditions, tips on how to talk with patients about health problems, treatment options and more.
Our series begins with heart disease. CDC data indicate that heart disease is the leading cause of death in men. Additionally, American Heart Association data suggest that more than one-third of all men in the United States have some type of CVD, whether it be coronary heart disease; stroke; high BP, cholesterol or other lipids; or heart failure.
Below, we discuss these issues with Michelle Kittleson, MD, PhD, cardiologist at Smidt Heart Institute at Cedars-Sinai, and Douglas K. Owens, MD, MS, general internist at Veterans Affairs Palo Alto Health Care System, and vice chair, U.S. Preventive Services Task Force. - by Janel Miller
Healio: What are some of the common risk factors for heart disease in men?
Kittleson: The traditional risk factors for heart disease in men include older age, men over the age of 45, smoking, high blood pressure, diabetes, obesity and a family history of coronary artery disease.
Healio: What are some ways primary care physicians can help prevent heart disease in general, and in patients with these risks?
Owens: One of the most important messages for all men to hear is that a healthy diet, and healthy lifestyle, getting sufficient exercise and not smoking are key things that they can do to prevent heart disease. We have recommendations around healthy lifestyle to counsel people to make changes if they need to, and that is the foundation of everything that a man can do to reduce his risk for heart disease. Specifically, the USPSTF recommends offering or referring adults who are overweight or obese and have additional CVD risk factors like the ones mentioned earlier to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention.
Healio: What are some of the more common treatment options in preventing heart disease?
Owens: The USPSTF recommends that all adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years begin a low-dose aspirin regimen for the primary prevention of CVD. While this same recommendation has a ‘C’ grade in adults aged 60 to 69 years, the evidence is insufficient in recommending this preventive measure in patients younger than 50 years and older than 70 years. In conjunction with these recommendations, clinicians and patients should discuss if taking an aspirin would help — patients should not begin taking aspirin on their own without any guidance from their doctor.
For men who have higher risk for CVD, statin therapy has proven very effective in reducing the chance of having a heart attack and stroke. We recommend men at higher risk discuss taking a statin with their clinicians, since these medications have important benefits and can decrease the chance of dying from cardiovascular disease.
Healio: What is a patient’s medical outlook if he follows the guidelines appropriate to his age and follows his medication regimen?
Kittleson: Heart disease will likely always be one of the most common killers of men because as you get older, heart disease is the final common pathway of many other conditions such as hypertension and diabetes. But it’s important to note that the severity and the age of presentation is increasing, and the prognosis is so much better than it used to be. This is due to greater awareness of the preventive measures, diagnostic tools, therapeutic approaches and interventions that we have now that have enabled heart disease to become a chronic treatable condition, rather than a uniformly progressive and fatal one. Editor’s note: Read Healio’s past coverage of some CVD diagnostic tools by clicking here.
Healio: How should physicians broach a subject like heart disease with their patients?
Kittleson: The most concerning symptom for heart disease is exertional intolerance; that is, symptoms that occur with exertion and get better at rest. So exercise is important for two reasons: first, patients who exercise on a regular basis are usually in better shape with less hypertension, diabetes, high cholesterol, and obesity. Second, regular exercise is a built-in early detection system; patients who exercise daily have a better sense how their heart is doing than someone who sits on the couch all day. So, my advice to primary care physicians would be to ask your patients about exercise and to be aware of subtle changes on their exercise tolerance, because if shortness of breath and chest pain are what’s limiting activities, then that’s a red flag for heart disease and warrant further discussions and testing.
CDC.gov. Men and heart disease fact sheet. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_men_heart.htm. Accessed May 29, 2018.
Heart.org. Statistical fact sheet 2016 update. Men and cardiovascular diseases.
Men’sHealthMonth.org. Men’s Health Month celebrated each June. http://www.menshealthmonth.org/. Accessed May 29, 2018.
USPreventiveServicesTaskForce.org. Final recommendation statement: Aspirin use to prevent cardiovascular disease and colorectal cancer: Preventive medication. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/aspirin-to-prevent-cardiovascular-disease-and-cancer. Accessed May 29, 2018.
USPreventiveServicesTaskForce.org. Final recommendation statement: Healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: behavioral counseling. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/healthy-diet-and-physical-activity-counseling-adults-with-high-risk-of-cvd. Accessed May 29, 2018.
Disclosures: Kittleson reports no relevant financial disclosures. Owens reports working with Zoll Inc. on a cost-effectiveness analysis of wearable cardioverter-defibrillators. He also has several publications related to these topics.