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Male Health Issues

By Antony Horner

A talk was delivered by Dr Lucy Roche, a registrar at the Royal Freeman Hospital in Newcastle, at our Annual Conference in September 2006. As this is a subject not widely covered, Antony Horner, our website specialist, very kindly took notes for GUCH News.

Dr Roche started by outlining the differences between men and women in general, and how these influence health.

  • Employment - Men tended to have more active jobs, and in many households are still the main breadwinner.
  • Health - Women live on average four years longer than men. Men also suffer from more chronic conditions, and for all leading causes of death, except Alzheimer's disease have a Higher Mortality rate.
  • Diet - Men tend to eat more salt, fat and meat, whilst eating less fruit and vegetables. They also tend to have higher Tobacco usage and Alcohol consumption, with a tendency towards binge drinking.
  • Risk Taking - They tend to enjoy more high risk sports than women and get into more physical fights, and crime than women, and are more likely to carry knives or other weapons. They also tend to have more sexual partners than women.
  • Stress - Women tend to handle stress better than men, by discussing issues with each other. Whilst men, tend to have a smaller social support network, and hide worries and concerns, employing avoidance techniques. These factors lead to poor outcomes from stressful events. For example men tend to cope less well with the death of a spouse and also have a higher suicide risk.
  • Use of Health Care Services - Men use fewer health care services than women. Up to 50% of men aged between 18 and 29 don't have a GP. They also make less visits to their doctors.
These factors are not helped by societies beliefs that men should be tough, independent and self reliant.

Factors effecting GUCH patients

In addition to the factors influencing the health of the general populous, GUCH patients also have additional factors. Research from the Mayo Clinic Research Institution in the U.S.A, on children with Congenital Heart Disease, stated that extended absences from school, scars, cyanosis and sports restrictions hindered friendships and conflicted with the sense of normality. This was causing teasing and low self esteem, and was much more noticeable in boys. Girls hid more behind make up and nail polish. The study found that girls had better ways of communicating, which allowed them to join in more.

Many GUCH patients have other medical problems in addition to their heart conditions. As they reach adulthood they have to learn to take responsibility for their own healthcare decisions. Medications also bring with them side effects, and patients have to learn to manage their own medication.

Exercise

As with the general population, exercise can also be of benefit to heart patients. It increases the functional capacity of the heart, and decreases the amount of oxygen the heart requires, thus making it more efficient. Studies done in Post Myocardial Infarction patients (heart attacks), have found that exercise improves survival, patients return to work quicker and have shorter hospital stays.

Patients should discuss with their doctors the type of activities that they should be doing. Echocardiograms and exercise stress tests can be used to assess an individuals capacity for exercise. If a patient has a specific sporting activity in mind, its possible to use the exercise stress test to mimic this type of activity. The main risk from sporting activities is arrhythmias.

In some patients it may be necessary to measure the pulmonary artery pressures, and to assess blood flow across residual shunts or holes. This would need to be done in the cath lab.

There is little evidence to show that activity or exercise results in death or that by not taking part in exercise or sporting activities, increases a person's life span. In fact only 10% of sudden deaths occur during exercise, compared to 58% at rest.

Most GUCHs fall somewhere between two extremes. Firstly patients who have fully repaired hearts or only mild problems, allowing them to function nearly normally in everyday life. Secondly those with severe deficits, whose functionality is not near that of their peers and whose lesion is still dangerous.

The first group generally have no restrictions in what sports they can take part in, though factors such as pacemakers may preclude contact sports. In the second group, sporting activity should be limited.

So to conclude sporting activity should be encouraged in patients that will benefit from it. But in high risk patients, the risks need to be managed.

Employment

As well as the financial benefits of employment, employment also increases self esteem and helps form friendships and build social networks. Unemployment results in a increased risk of suicide and depression. Women cope with the effects of unemployment better than men. Unemployment in GUCH patients is higher than that of the general population.

Sexual health

There is no published data on Male GUCH Sexual Health. The only data that exists is on patients who have had Myocardial Infarctions (heart attacks), or who have heart failure.

Studies have shown that during sex, the average male heart rate raises to between 120bpm - 130bpm, with the systolic blood pressure rising to 130. The sexual act itself is the equivalent to a 4 minute treadmill test using the Bruce Protocol.

Many patients are concerned about the risk of death as a result of having sex, but this is very rare. Again no data exists for GUCH patients, but a healthy 50 year old male has a 1% risk of sudden death. During sex, this rises to 1.01%. For a post MI 50 year old male this rises to 1.1%. So whilst there is a increased risk, it is still very low.

Erectile Dysfunction (ED), or the inability to sustain an erection is increasingly a problem. The condition causes both relationship and mental health issues. There is a strong link between ED and vascular diseases, in particular Heart Failure, Diabetes, Hypertension and Coronary Heart Disease. Smoking is also a factor in ED.

Medication can also contribute to ED and other sexual problems, in particular Thiazide Diuretics, Beta Blockers, Hypertensive medications and ACE Inhibitors. It's important to identify where medication is responsible for sexual problems, as patients experiencing sexual problems as a result of medication, are most likely to stop taking their medications.

One thing that became clear from Dr Roche's talk, was that whilst there is data on the sexual health of women with Congenital Heart Disease, there was none on Men with Congenital Heart Disease. The possibility of undertaking a study was discussed after the talk. We will let you know if such a study takes place, and bring you the results.

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