US Pharm. 2006;8:8-10.

In 1990, there were more than 120 million men of all ages, races, and ethnicities living in the United States. Each racial and ethnic group has its own unique geographic pattern of population clusters, concentrations, and dispersions. The majority of the population in the U.S. is white. Black men are the second most numerous and geographically dispersed group of men in the nation. For many men in the U.S., there are substantial barriers to receiving needed medical care. These barriers include poverty, lack of health insurance, rural isolation, social isolation, and absence of cardiac care physicians and facilities in their communities. Men of minority racial or ethnic groups may be particularly disadvantaged in their access to medical care resources in underserved areas. For example, in 1990, 70% of counties in the U.S. had no cardiovascular disease–specialty physicians.

During the 20th century, the leading causes of death in the U.S. shifted from infectious to chronic diseases (e.g., cardiovascular disease, cancer, diabetes). Chronic diseases are now among the most prevalent, costly, and preventable of all health problems and account for seven of the 10 leading causes of death in the U.S. Chronic diseases affect the quality of life of 90 million U.S. residents, and the cost of medical care for those with these diseases accounts for 70% of total medical care expenditures. Additionally, early detection and treatment of chronic diseases can enhance a patient's quality of life. Clinical preventive services can keep debilitating complications of diabetes and cardiovascular disease at bay. In the 1980s and 1990s, the CDC and state health agencies collaboratively developed additional surveillance systems to monitor behavioral risk factors for chronic disease.

Men have approximately one and one-half times the death rate from cardiovascular diseases as women. Furthermore, men have approximately one and one-half times the death rate from total cancers as women and two times the death rate from lung cancer as women. Men have approximately one and one-half times the death rate from colorectal cancer as women. More than two thirds of men are overweight or obese. At least 58 million Americans have some form of cardiovascular disease, including high blood pressure, and 8.2 million Americans have a history of cancer.

Heart Disease
In 2002, 340,933 men died from heart disease, the leading cause of death for men in the U.S. The age-adjusted rate for heart disease in men was 297 per 100,000 population. About 8.9% of all white men, 7.4% of black men, and 5.6% of Mexican-American men live with coronary heart disease (CHD). The average age of a first heart attack for men is 66 years. Almost half of men who have a heart attack when they are younger than age 65 die within eight years. Results from the Framingham Heart Study suggest that men have a 49% lifetime risk of CHD after age 40. Between 70% and 89% of sudden cardiac events occur in men. Major risk factors for heart disease include high blood pressure, high blood cholesterol, tobacco use, diabetes, physical inactivity, and poor nutrition. A large study of blood pressure treatment and control showed that an average reduction of 12 to 13 mmHg in systolic blood pressure over four years of follow-up was associated with a 21% reduction in CHD, a 37% reduction in stroke, and a 13% reduction in all-cause mortality rates. Studies suggest that a 10% decrease in total cholesterol levels may reduce CHD risk by as much as 30%.

Cancer
Prostate cancer is the most common form of cancer, other than skin cancer, among men, and is second only to lung cancer as a cause of cancer-related death among men. The American Cancer Society estimated that in 2003, about 220,990 new cases of prostate cancer would be diagnosed and 28,900 men would die of the disease. About 70% of all diagnosed prostate cancers are found in men age 65 years or older. Over the past 20 years, the survival rate for prostate cancer has increased from 67% to 97%. The prostate cancer death rate is higher for African-American men than for any other racial or ethnic group. Compared to other racial and ethnic groups, the Asian/Pacific Islander group has relatively low rates of prostate cancer incidence and mortality. Among all racial and ethnic groups, prostate cancer death rates were lower in 1999 than they were in 1990. The decrease in prostate cancer death rates from 1990 to 1999 was almost twice as great in whites and Asian/Pacific Islanders than in African-Americans, Native American/Alaska Natives, and Hispanic Americans. Use of herbal supplements, diets high in fat or low in fruits and vegetables, consumption of vitamin E or selenium, certain infectious diseases, and men's hormonal characteristics are factors being studied to determine the causes of prostate cancer. More than ever before, medicines offer hope to those with cancer. Today, there are 399 medicines in development to treat cancer, including 50 for prostate cancer, according to the Pharmaceutical Research and Manufacturers of America.

Diabetes
Diabetes is associated with an increased risk for a number of serious--sometimes life-threatening--complications, and certain populations experience an even greater threat. Although good diabetes management can help reduce the risk of complications, many people are not even aware that they have diabetes until they develop a complication. About 10.9 million men (or 10.5% of all men age 20 years or older have diabetes, although nearly one third do not know it. Men with diabetes are two times as likely to experience erectile dysfunction as are men without diabetes. Deaths from heart disease in men with diabetes have decreased by only 13%, compared to a 36% decrease in men without diabetes. More than 60% of nontraumatic lower-limb amputations occur in people with diabetes. In 2002, about 82,000 nontraumatic lower-limb amputations were performed in people with diabetes. Amputation rates are 1.4 to 1.7 times higher for men than for women with diabetes.

Risk factors for diabetes include poor nutrition, lack of physical activity, and obesity. Findings from the CDC's Diabetes Prevention Program showed that a healthful diet, which includes fruits and vegetables, and exercise can reduce the risk of diabetes in high-risk populations.

Diabetes mellitus is one of the most serious health challenges facing the African-American community, with 2.8 million African-Americans suffering from it. For every six white persons with diabetes, 10 African-Americans have the disease. African-Americans have a 27% higher mortality rate from diabetes than do white persons.

Preventive maintenance is an important factor in ensuring good health. Taking care of oneself often includes lifestyle and behavior changes that may be difficult at first. For instance, being overweight or obese can raise the risk of many cancers; getting enough exercise can significantly lower these risks. It is also important that patients follow through with their treatments. Until recently, killing cancer cells without harming healthy cells in the body was extraordinarily difficult, but that is changing. Right now, America's pharmaceutical company researchers are creating new "smart" medicines that ignore healthy cells and go straight to the cancer. In addition, companies are working on medicines to improve the quality of life for people undergoing cancer treatment.

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