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Cardiovascular disease in men

Cardiovascular disease in men. Susan Neal Nurse Practitioner North Street Medical Care. Sex is bad for you. Burden of heart disease for men Some theories Issues for care and service delivery Some innovative approaches. The stronger sex?.

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Cardiovascular disease in men

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  1. Cardiovascular disease in men Susan Neal Nurse Practitioner North Street Medical Care

  2. Sex is bad for you • Burden of heart disease for men • Some theories • Issues for care and service delivery • Some innovative approaches

  3. The stronger sex? • Mortality greater for males of all ages in all death causes • Life expectancy lower • Especially accentuated for lower social classes

  4. <1yr 1-15 16-34 35-54 55-64 65-74 75 + all ages Male 6.4 0.2 1.0 3.0 12.5 34.8 110.1 10.9 1997 2021 Female 5.2 0.2 0.4 1.9 7.5 21.1 88.7 11.5 Male Female Male Female At birth 74.6 79.6 78.6 82.7 Age 20 55.5 60.3 59.1 63.1 Age 60 18.8 22.6 22.0 25.1 Table showing deaths by gender and age – United Kingdom, 1998 (Death rates per 1000 in each age group) Table showing expectation of life by gender, UK

  5. Men Women Class Years At age Years At age 1 and 2 74.9 15.0 80.2 18.7 3 (Non-manual) 73.5 14.1 79.4 18.3 Table showing life expectancy by social class – England and Wales, 1987-91

  6. Causes of Death Male Female All causes 1014.0 1078.50 All cancers 273.2 242.6 Lung cancer 73.5 41.6 Colon, rectum, bowel 29.6 26.9 Prostate cancer 33.1 ------- Breast cancer ------- 43.8 Ischaemic heart disease 251.3 203.9 Cerebrovascular disease 82.0 134.1 All accidents 23.5 16.1 Road vehicle accidents 8.9 3.3 Suicide 15.5 4.8 Table showing death rates for selected causes of death – England, 1998(Deaths per 100,000 population)

  7. Cardiovascular disease • Annually 100,000 men die from CHD (80,000 women) • Men below 50 have six fold higher risk than women • 1/12 men die of CHD before retirement • 50% of all deaths in working age group • 2/3rds all deaths from heart attacks are men

  8. Men develop CHD on average 10 years earlier than women • Unskilled working men are 3 times more likely to die prematurely of CHD than men in professional/managerial classes • Rates reducing but less so in lower social classes

  9. A disease of men? • Most research focused on men • Perception of CHD as disease of men • Sex difference in management becoming apparent • Where are men in the NSF?

  10. Some theories for the male excess of CHD • Sex hormones – oestrogen increases levels of HDL cholesterol (25% higher in women) testosterone may cause lower levels of HDL • Body fat distribution – accumulation to upper body (men), thighs and buttocks women. Waist to hip ratio may be associated with HDL:LDL ratio. Central obesity greater predictor of risk • Stress reaction • Mild to moderate vertex baldness associated with 40% increase in MI, severe baldness 340% increase.

  11. Smoking – accounts for 25% of deaths from CHD • In 2000 29% men & 25% women smoked • Higher in manual groups 32% • Highest prevalence men age 16-44 • Rates falling but may be levelling off

  12. Diet – women eat more fruit and veg hence have higher antioxidant intake. Men have higher dietary fat intake • Exercise – men tend to take more than women

  13. Health preservation and illness behaviour • From early life boys perceive themselves less vulnerable and susceptible to illness • Men more likely to engage in risk taking behaviour • Reluctant to act on symptoms • Reluctant to accept health promotion • Adoption of “sick role” difficult

  14. Table showing consultations with an NHS GP in past 14 days – Great Britain 1996 (percentages) Age Males Females 16-44 10 20 45-64 15 19 All ages 13 19 Age Males Females 16-44 3 7 45-64 5 6 All ages 4 6 Table showing average no. of NHS GP consultations per person per annum – Great Britain, 1996

  15. Visit doctor less • Present at later stage of illness • Have less intimate relationship with care providers • Less able to discuss, disclose and share. Constrained by social taboos & embarrassment • Less chance for opportunistic health promotion eg BP more likely to have been recorded in women • Less likely to respond to invitations for screening • Wives very instrumental in changing behaviour • Role of other family members in determining lifestyle and illness behaviour (OXCHECK Study)

  16. Views on exercise & fitness • Normalise tendency to overweight with age • Preoccupation with physical appearance is a “woman thing” • Know little about nutritional content of food • Keeping fit seen as “middle class” activity • Team sports preferred to individual exercise • Competitive element appreciated • Awkward about group exercise • Workplace seen as good place for health promotion

  17. Implications for Service Delivery • ? Is primary prevention for CHD in the surgery worthwhile? • Secondary prevention needs to be targeted and appropriate • Little evidence about what works • Family centred approach • Are surgery services man friendly?? • Key stages of life may be targeted with different approaches • ? Specialist workers • Outreach • Male friendly media

  18. Outreach schemes • Taking screening to the workplace and leisure place – pubs, clubs, factories, sports grounds, betting shops

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