California Men's Health Research Articles

Statins as a free pass: Body mass index and other cardiovascular risk factors among lipid-lowering medication users and nonusers in the California Men's Health Study

To lower risk from cardiovascular disease (CVD), national guidelines recommend lifestyle changes followed by use of lipid-lowering medications when appropriate. Previous studies have questioned whether individuals taking these medications are less likely to modify their dietary intake and physical activity, resulting in increased body mass index (BMI). We assessed BMI and CVD clinical risk factors over time between lipid-lowering medication users and nonusers in a diverse cohort of middle-aged and older men. The cohort consisted of 63,357 men who enrolled in the California Men's Health Study between 2002 and 2003 and were not taking lipid-lowering medications at baseline. Lipid-lowering medication use was determined over twelve years of follow-up. BMI and other CVD risk factors were assessed with longitudinal linear mixed effect models adjusting for possible confounders. Overall, lipid-lowering medication users had higher BMI than nonusers (p < .0001); however, there was a decrease over time for both groups (p < .0001). Total cholesterol, LDL-C, and triglycerides decreased for users and nonusers (p < .0001). While HDL-C was higher for nonusers (p < .05), over time this measure increased in both groups (p < .0001). We found no evidence of increases in BMI after initiation of lipid-lowering medication in this cohort. Instead, BMI decreased and several cholesterol-related CVD risk factors improved for lipid-lowering medication users and nonusers. This suggests that men placed on lipid-lowering medications do not view them as a panacea for their increased risk of cardiovascular disease. Instead, they appear to perceive them as one component of a multi-pronged strategy including lifestyle and nutrition as suggested by current guidelines.

Diet-related inflammation and risk of prostate cancer in the California Men's Health Study

PurposeThe purpose of the study was to examine the relationship between proinflammatory diet and prostate cancer risk. MethodsEnergy-adjusted Dietary Inflammatory Index (E-DII) scores were computed among 40,161 participants in the California Men's Health Study. Over 9.7 ± 3.8 years of follow-up, 2707 incident prostate cancer cases were diagnosed and categorized as low-, intermediate-, or high-risk, based on disease grade and stage. Accelerated failure-time models assessed time to diagnosis of prostate cancer. Cox proportional hazard models estimated hazard ratios (HR) and 95% confidence intervals (95% CI). Nonlinear effects of E-DII were modeled as third-order polynomials. ResultsTime to prostate cancer diagnosis did not differ by E-DII quartile. The HR for high-risk prostate cancer increased in the third E-DII quartile (HRQ3 vs. Q1 = 1.36; 95% CI: 1.04–1.76), but not in the fourth (HRQ4 vs. Q1 = 0.99; 95% CI: 0.74–1.32, Ptrend = .74), suggesting a nonlinear dose–response. HR curves for prostate cancer increased exponentially above an E-DII threshold of ≈+3.0. HR curves for high-risk prostate cancer had a much steeper incline above an E-DII threshold of ≈+2.5. Curves were higher among Blacks and Whites relative to other races and among overweight or obese men. No relationship was observed between E-DII scores and intermediate- or low-risk disease. ConclusionsRelationships between proinflammatory diet and prostate cancer risk may be nonlinear, with an increased risk above an E-DII threshold of ≈+2.5.

Abstract 2968: Imputation of the prostate cancer transcriptome in over 230,000 men reveals novel germline-somatic interaction mechanism of cancer risk

Abstract Although genome-wide association studies of prostate cancer have revealed numerous genetic loci associated with disease risk, efforts to characterize the causal mechanisms of germline genetic variants have been unsystematic in their approach. While select studies have evaluated the effects of the most significantly associated variants on the expression of highly proximal genes, both the complex nature of gene expression regulation, as well as the majority fraction of prostate cancer risk unaccounted for by genome-wide association study loci, suggest that certain risk genes and variants remain undiscovered. In pursuit of such causal genetic factors, we analyzed germline genotype data paired with gene expression data from normal prostate tissue in 471 subjects to build regularized statistical models of how gene expression of the prostate is influenced by cis-genetic variation. By applying these models to genome-wide association study data, predictions of transcript expression levels were generated transcriptome-wide for over 230,000 male subjects (14,616 prostate cancer cases, 219,339 controls) from the UK Biobank, GERA Cohort, ProHealth Study, and California Men's Health Study. Finally, these transcript abundances were assessed in relation to prostate cancer case-control status to identify those genes with expression levels most predictive of prostate cancer diagnosis. Among the 12,014 genes for which models were successfully fit, 29 were transcriptome-wide significant via Bonferroni correction, while another 9 exhibited p-values that were suggestive. Moreover, 19 of the 38 significant or suggestive genes replicated in the validation cohort of Kaiser Permanente health plan members (GERA, ProHealth, CMHS). At previously implicated risk loci for prostate cancer, numerous genes were significantly associated with disease risk, including MSMB, NCOA4, and AGAP7 at 10q11.22, HNF1B at 17q12, as well as POU5F1B and PCAT1 at 8q24.21. Furthermore, several genes whose expression levels were not previously implicated were associated with prostate cancer risk. The most noteworthy of these was TMPRSS2, part of the TMPRSS2-ERG gene-fusion, which represents the most frequent somatic alteration discovered in prostate cancer tumors. When conditioned on a previously reported prostate cancer GWAS cis-variant at 21q22.3, TMPRSS2 retained transcriptome-wide significance. Further analysis of the genetic effects on TMPRSS2-ERG expression in prostate cancer tumors from The Cancer Genome Atlas (TCGA) suggested a novel mechanism by which germline and somatic factors cooperate to increase disease risk. By systematically characterizing gene expression of the prostate in this transcriptome-wide association study (TWAS) of prostate cancer, we identified prostate cancer risk genes and propose a novel germline-somatic interaction mechanism of cancer risk. Citation Format: Nima C. Emami, Joshua Hoffman, Elad Ziv, John S. Witte. Imputation of the prostate cancer transcriptome in over 230,000 men reveals novel germline-somatic interaction mechanism of cancer risk [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2968.

The Relationship Between Nonsteroidal Anti-inflammatory Drug Use and Age-related Macular Degeneration

To describe the relationship between the incidence of age-related macular degeneration (AMD) and nonsteroidal anti-inflammatory drug (NSAIDs) use. Prospective cohort study. This study consisted of participants in the California Men's Health Study. Those who completed surveys in 2002-2003 and 2006 were included. Men who self-reported use of aspirin, ibuprofen, naproxen, valdecoxib, celecoxib, and/or rofecoxib at least 3days per week were considered NSAID users. Patients were categorized as non-users, former users, new users, or longer-term users based on survey responses. NSAID use was also categorized by type: any NSAIDs, aspirin, and/or non-aspirin NSAIDs. Age, race/ethnicity, smoking status, education, income, alcohol use, and Charlson comorbidity index score were included in the multivariate analysis as risk factors for AMD. A total of 51 371 men were included. Average follow-up time was 7.4 years. There were 292 (0.6%) and 1536 (3%) cases of exudative and nonexudative AMD, respectively. Longer-term use of any NSAID was associated with lower risk of exudative AMD (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.50-0.96, P= .029). New users of any NSAIDs (HR= 0.79, 95% CI 0.68-0.93, P= .0039) and aspirin (HR= 0.82, 95% CI 0.70-0.97, P= .018) had a lower risk of nonexudative AMD, although this trend did not persist in longer-term users. The relationship between exudative or nonexudative AMD and the remaining categories of NSAID use were not significant. The overall impact of NSAIDs on AMD incidence is small; however, the lower risk of exudative AMD in longer-term NSAID users may point to a protective effect and deserves further study as a possible mechanism to modulate disease risk.

Longitudinal study of body mass index in Asian men who immigrate to the US.

Cross-sectional studies indicate that adaptation to Western norms, especially at a younger age, might explain the higher average body mass index (BMI) among Asians living in the United States (US) compared to Asians living in Asia. However, migrants differ from non-migrants in sociocultural factors that are difficult to measure and, thus, longitudinal studies on the same individuals prior to and after immigration are needed. The objective of this study was to determine differences in changes in BMI across age by residence (US or Asia) and age at immigration using longitudinal data on BMI prior to and after immigration. The California Men's Health Study includes 1,549 foreign-born Asian men who were aged 44-71 at baseline in 2002-03. BMI at ages 30, 40, 50 and 60 was calculated using self-reported weight history and current height. Residence at each age decade and age at immigration were determined. Data were analyzed using generalized estimating equations. Ten-year BMI increases were smaller among Asians who lived in Asia prior to migrating to the US compared to those who already lived in the US. This effect was most evident be-tween ages 30-40 when Asians in Asia had a 0.69 kg/m2 (95% CI: -1.08, -0.30) smaller increase in BMI. Immigrants who moved to the US before age 40 experienced greater increases in BMI than immigrants who moved to the US at an older age. This study is the first to support the hypothesis that living in the US and younger age at immigration results in larger BMI increases in Asian men.

Longitudinal study of acculturation and BMI change among Asian American men

BackgroundCross-sectional studies examining the association between Western acculturation and BMI in Asians have been inconsistent, and studies on BMI change are lacking. ObjectiveThis study examined the associations between indicators of acculturation (generational status, length of US residence, and age at immigration) and overweight (BMI ≥25kg/m2) as well as 5-year BMI changes in 7,073 Chinese, Japanese, Korean, Filipino, and Vietnamese men who lived in the US and were 44–71years old at baseline of the California Men's Health Study (2002–2003). MethodsIndicators of acculturation were reported at baseline. Repeated clinical measures of BMI were extracted from electronic health records (2005–2012). ResultsUsing generalized estimating equations we found that lower generational status, shorter duration of US residence and older age at immigration were inversely associated with being overweight. However, analysis of BMI curves using linear mixed models showed that shorter length of US residence and older age at immigration were associated with larger 5-year increases in BMI. ConclusionsAsian immigrants who were less acculturated had larger BMI increases as they became more acculturated but had not achieved overweight status. Healthy weight interventions among Asians immigrants may be most effective when targeting weight maintenance early in the process of acculturation.

Association Between Cannabis Use and the Risk of Bladder Cancer: Results From the California Men's Health Study

To investigate the association of cannabis use and tobacco smoking on the incidence of bladder cancer within the California Men's Health Study cohort. We evaluated the records of 84,170 participants in a multiethnic cohort of men aged 45-69years. Information on demographic and lifestyle factors including smoking history and cannabis use was collected using mailed questionnaires between 2002 and 2003. We linked the study data with clinical records including cancer data from electronic health records. Overall 34,000 (41%) cohort members reported cannabis use, 47,092 (57%) reported tobacco use, 22,500 (27%) reported using both, and 23,467 (29%) used neither. Men were followed over an 11-year period and 279 (0.3%) developed incident bladder tumors. Among cannabis users, 89 (0.3%) developed bladder cancer in comparison to 190 (0.4%) men who did not report cannabis use (P< .001). After adjusting for age, race or ethnicity, and body mass index, using tobacco only was associated with an increased risk of bladder cancer (hazard regression [HR], 1.52; 95% confidence interval [CI], 1.12-2.07), whereas cannabis use only was associated with a 45% reduction in bladder cancer incidence (HR, 0.55; 95% CI, 0.31-1.00). Using both cannabis and tobacco was associated with an HR of 1.28 (95% CI, 0.91-1.80). Although a cause and effect relationship has not been established, cannabis use may be inversely associated with bladder cancer risk in this population.

Progression and treatment of incident lower urinary tract symptoms (LUTS) among men in the California Men's Health Study.

To characterise the progression and treatment of lower urinary tract symptoms (LUTS) among men aged 45-69 years in the California Men's Health Study. A total of 39,222 men, aged 45-69 years, enrolled in the Southern California Kaiser Permanente Health Plan were surveyed in 2002-2003 and again in 2006-2007. Those men who completed both surveys who did not have a diagnosis of benign prostatic hyperplasia (BPH) and were not on medication for LUTS at baseline were included in the study (N = 19,505). Among the men with no or mild symptoms at baseline, the incidence of moderate/severe LUTS (American Urological Association Symptom Index [AUASI] score ≥8) and odds of progression to severe LUTS (AUASI score ≥20) was estimated during 4 years of follow-up. Of the 9640 men who reported no/mild LUTS at baseline, 3993 (41%) reported moderate/severe symptoms at follow-up and experienced a 4-point change in AUASI score on average. Of these men, 351 (8.8%) had received a pharmacological treatment, eight (0.2%) had undergone a minimally invasive or surgical procedure and 3634 (91.0%) had no treatment recorded. Men who progressed to severe symptoms (AUASI score ≥20; n = 165) were more likely to be on medication for BPH (odds ratio [OR] 8.09, 95% confidence interval [CI] 5.77-11.35), have a BPH diagnosis (OR 4.74, 95% CI 3.40-6.61) or have seen a urologist (OR 2.49, 95% CI 1.81-3.43) when compared with men who did not progress to severe symptoms (AUASI score <20). These data show that the majority of men who experienced progression did not have pharmacological or surgical therapy for their symptoms and, therefore, may prove to be good candidates for a self-management plan.

PS1-47: Clinical Risk Factors for Cardiovascular Disease in Asian-Indian and Non-Hispanic White Men in the California Men's Health Study

Background/Aims Asian-Indians (AIs) have disproportionately higher rates of cardiovascular disease (CVD) than most racial/ethnic groups. We evaluated clinical risk factors including diabetes mellitus (DM), hypertension (HTN), and dyslipidemia in AI men compared with non-Hispanic white (NHW) men enrolled in the California Men’s Health Study (CMHS).

Impact of type 2 diabetes on lower urinary tract symptoms in men: a cohort study

BackgroundStudies of the impact of type 2 diabetes on the prevalence and incidence of lower urinary tract symptoms (LUTS) among men have provided divergent results. We sought to examine this issue using two large and diverse cohorts.MethodsThis study used questionnaire and clinical data from two large multiethnic cohorts, the California Men’s Health Study (CMHS) and Research Program in Genes, Environment and Health (RPGEH). Diabetes characteristics data were derived from questionnaire and Diabetes Registry data. LUTS were measured using a standardized scale. Socioeconomic and comorbidity data were obtained by self-report.Multivariable logistic regression analysis was used to examine the association between baseline DM status and prevalence and incidence of LUTS, with adjustment for potential confounding variables.ResultsWe found type 2 diabetes to be associated with prevalent LUTS (odds ratio (OR) = 1.32, 95% confidence interval (CI) 1.26, 1.38). The association was stronger among men with type 2 diabetes who were on active pharmaceutical treatment and had it for a longer duration. No association was observed between type 2 diabetes and new onset LUTS.ConclusionsType 2 diabetes increases the risk of LUTS.

PS1-02: Health Behaviors in Asian-Indian and White, Non-Hispanic Vegetarian Males in the California Men's Health Study (CMHS)

Background Studies show a reduced risk of chronic diseases among vegetarians. A vegetarian diet based on fruits, vegetables, and legumes is popular among Asian-Indians. The purpose of this study is to determine if race/ethnicity, Asian-Indian and white non-Hispanic (WNH), modifies the association between a vegetarian diet and health behaviors.

Clinical effectiveness of pneumococcal polysaccharide vaccine in men: California Men's Health Study

ObjectiveTo examine the effectiveness of pneumococcal polysaccharide vaccine (PPV) among approximately 40,000 community-dwelling men aged 45years and older in the California Men's Health Study (CMHS) cohort. MethodsAll participants completed an extensive questionnaire at baseline (2002–2003) and were followed for the occurrence of invasive pneumococcal disease (IPD) or all-cause pneumonia hospitalization through the end of 2009. Immunization status and incident IPD and pneumonia cases were ascertained through electronic medical records. The associations between vaccination and IPD or pneumonia hospitalization were assessed using time-dependent Cox proportional models to account for sociodemographics, time-updated vaccination status, and comorbidities. ResultsThe median follow-up period of the 39,222 participants was 7.3years. Among them, 11,902 (30.3%) had received at least one PPV vaccine at baseline and 7653 (19.5%) received their first PPV vaccine during the follow-up. There were 17 pneumococcal bacteremia cases, 647 hospitalized pneumonia cases, and no pneumococcal meningitis cases. The results suggested a reduced risk of pneumococcal bacteremia among men vaccinated at age ≥65 (adjusted hazard ratio [HR]: 0.35; 95% confidence interval [CI]: 0.06–1.91; p=0.22). PPV vaccination did not show a protective effect against all-cause pneumonia hospitalization (adjusted HR: 1.18; 95% CI: 1.02–1.37, p=0.03) among men vaccinated before 65years old, but a moderate protective effect was suggested among men without chronic obstructive pulmonary diseases who were vaccinated after 65years old (adjusted HR: 0.84; 95% CI: 0.67–1.06, p=0.15). ConclusionsThe findings in this large cohort of men in Southern California suggested a benefit of PPV for protection against pneumococcal bacteremia among men vaccinated at age 65years and older. PPV might not provide adequate protection against all-cause pneumonia hospitalization among men.

Abstract 3578: The use of preventive services among prostate cancer survivors

Abstract Introduction and Objectives: It is well established that most men diagnosed with prostate cancer die from other causes. However, concerns have been expressed that the diagnosis often focuses subsequent care on prostate-related issues rather than overall health. We sought to determine if the use of general preventive services were diminished in a cohort of men following their diagnosis of prostate cancer. Methods: Using the California Men's Health Study, a prospective cohort study of over 40,000 men ages 45-69 years at baseline in 2002 who were recruited through the Kaiser Permanente Southern California Health Plan, we identified 1636 men who were newly diagnosed with prostate cancer from 2002 through 2008. Preventive services evaluated included screening for colorectal cancer (colonoscopy and/or fecal occult blood tests (FOBT)), tests for diabetes (glucose and hemoglobin A1c) and heart disease (serum cholesterol, high density lipoprotein (HDL) and triglycerides) and vaccinations (influenza and pneumococcal). The use of preventive services was compared in the two years prior to and following prostate cancer diagnosis using matched odds ratios (MOR) and 95% confidence intervals (CI) adjusted for baseline age, Charlson comorbidity index, education, smoking and income. Results: Of the 1636 men diagnosed with prostate cancer, men were equally as likely to receive a pneumococcal vaccination, a hemoglobin A1c or glucose test for diabetes and screening for colorectal cancer before and after prostate cancer diagnosis (Pneumococcal MOR: 1.00, 95% CI: 0.72-1.37; Hemoglobin A1c MOR: 1.01, 95% CI: 0.51-2.01; Glucose MOR: 1.07, 95% CI: 0.71-1.60; Colorectal cancer screening MOR: 0.91, 95% CI: 0.56-1.47). The adjusted odds of receiving an influenza vaccine were 2.6 times greater after prostate cancer diagnosis when compared to before diagnosis (MOR: 2.62, 95% CI: 1.53-4.49). However, men were approximately 70% less likely to receive a cholesterol test (MOR: 0.30, 95% CI: 0.15-0.59) and HDL test (MOR 0.32, 95% CI: 0.16-0.62) following prostate cancer diagnosis. Also, men were approximately 50% less likely to receive a triglyceride test after diagnosis when compared to before prostate cancer diagnosis (MOR 0.51, 95% CI: 0.29-0.89). Conclusions: Results from this study suggest that once diagnosed with prostate cancer, less attention is paid to preventive care for heart disease. As more men with prostate cancer die from causes other than their cancer, screening for and maintenance of preventable diseases of aging is critical and warrants improvement. This analysis also highlights the importance of transitioning care back to primary care physicians after men have undergone treatment for prostate cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3578. doi:1538-7445.AM2012-3578

Evaluating Racial/Ethnic Disparities in Lower Urinary Tract Symptoms in Men

We examined whether there are racial/ethnic disparities in lower urinary tract symptoms in men. Racial/ethnic disparities were examined using the American Urological Association symptom index in 2 large cohorts, including the California Men's Health Study and the Research Program in Genes, Environment and Health. Prevalence and incidence were calculated in each age and race/ethnicity strata. Multivariate analysis was done to assess the association between race/ethnicity and lower urinary tract symptoms. The lower urinary tract symptom prevalence increased with age in each racial/ethnic category (p <0.05). The mean ± SD age adjusted American Urological Association symptom index score for black, Hispanic, other/mixed, non-Hispanic white and Asian men was 9.57 ± 5.83, 9.35 ± 6.30, 9.32 ± 6.22, 8.99 ± 5.89 and 8.41 ± 5.59, respectively. In multivariate models Hispanic and black men were at increased risk for moderate lower urinary tract symptoms than white men while only Hispanic men were at higher risk for severe lower urinary tract symptoms. Asian men were at lower risk for moderate or severe lower urinary tract symptoms than white men. The incident rate of lower urinary tract symptoms increased with increasing baseline age for almost all racial/ethnic groups (range 32% to 56%). Asian and Hispanic men were at lower risk for incident lower urinary tract symptoms than white men even after adjusting for sociodemographic factors, health related behaviors and comorbidity. Racial/ethnic disparities in lower urinary tract symptoms persist after accounting for putative and established risk factors.

Population‐based study of erectile dysfunction and polypharmacy

Study Type - Symptom prevalence (population cohort). Level of Evidence 1b. What's known on the subject? and What does the study add? It is known that medical conditions such as diabetes, high blood pressure, high cholesterol, smoking and prescribed medications cause erectile dysfunction (ED). This has been studied at the molecular level and reported in population studies. The present study shows that, after accounting for known medical problems, there is a dose-response relationship, in which worsening degrees of ED are seen when a greater number of medications are taken, regardless if they are prescribed or over the counter. The study can help primary care doctors and urologists to make a differential diagnosis of ED and it can also help improve patient's erectile function by tailoring and curtailing current medication use to maximize therapeutic benefit but minimize ED side effects in men, thus improving health-related quality of life. • To study the association between erectile dysfunction (ED) and polypharmacy use in a large, ethnically and racially diverse cohort of men enrolled in the California Men's Health Study (CMHS). • Men from the Kaiser Permanente Southern California (KPSC) health plan, enrolled in the CMHS in 2002, had an age range of 45-69 years. ED and comorbidities of these subjects were identified by questionnaire responses. • The number of drugs taken was determined from the year before enrollment through electronic pharmacy records and questionnaire responses. • Among the 37 712 (KPSC) subjects, 10 717 (29%) reported moderate or severe ED. • Across all age groups, ED was more prevalent as the number of medications increased. • In men taking 0-2, 3-5,6-9 and ≥ 10 medications, the percentage of men reporting moderate ED was 15.9, 19.7, 25.5 and 30.9%, respectively (P < 0.001). • With adjustment for age, race, smoking, diabetes, hypertension, hyperlipidaemia, peripheral vascular disease, coronary artery disease and body mass index, men taking >10 drugs were more likely to have ED (odds ratio = 2.32, 95% confidence interval 2.14-2.52) with evidence of a dose-response relationship. • These data suggest that the number of medications a man takes is associated with worse ED, even after comorbidities have been taken into account.

C-C3-04: A Comparison of Cardiovascular Disease Risk Factors in Asian-Indian and White, Non-Hispanic Men in the California Men's Health Study

BackgroundAsian-Indians are the third largest group among Asians in the US. Between 1990 and 2000, the Asian-Indian population in California doubled in size from 93,557 to 200,633. Cardiovascular disease (CVD) rates are substantially higher in Asian-Indians compared to other racial/ethnic groups. The purpose of this study is to evaluate lifestyle CVD risk factor differences between Asian-Indian and white, non-Hispanic (WNH) men. Subjects are participants in the California Men’s Health Study (CMHS), a multiethnic cohort of 84,170 men 45–69 years of age enrolled in Kaiser Permanente Southern and Northern California at baseline (2001–02).MethodsA mailed survey collected demographic and lifestyle characteristics. Descriptive analyses and multivariable logistic regression, adjusting for demographics, were performed to evaluate the survey data.ResultsThe CMHS cohort is comprised of WNH (62%, 51,909/84,170), 14% (11,407/84,170) Hispanic, 8% (6,298/84,170) African-American, 11% (8,705/84,170) Asian/Pacific Islander, and 5% (6,733/84,170) other/mixed men. Of the 8,705 Asian/Pacific Islanders, 602 identified themselves as Asian-Indian. Although most Asian-Indian men were first generation immigrants (94%, 568/602), over three-fourths had resided in the US for 16+ years. Age distribution did not differ between Asian-Indian and WNH men. Asian-Indians were more likely than WNHs to live in a low income household (22%, 134/602 vs. 15%, 7,963/51,901), yet had considerably higher educational attainment (77% v 53%, with college degree). Asian-Indian men more often reported a healthy BMI (18.5–24.9) [Adjusted Odds Ratio (AOR) = 1.83 (95% CI 1.54–2.18)] and more often consumed 3.5 hours/week [AOR = 0.54 (95% CI 0.46–0.64)], there was little difference in sedentary activity time spent outside of work.ConclusionDespite a higher prevalence of CVD among Asian Indian men, in the CMHS we found Asian-Indian men had fewer CVD-related lifestyle risk factors. These results suggest risk factors other than lifestyle behaviors may be major contributors to CVD in the Asian Indian population.

Contribution of Common Medications to Lower Urinary Tract Symptoms in Men

While benign prostatic hyperplasia (BPH) is the commonest cause, the etiology of lower urinary tract symptoms (LUTS) is multifactorial. BPH clinical guidelines suggest evaluating other potential sources of LUTS (e.g., concomitant medication use) before initiating pharmacotherapy or surgical intervention.1 Through effects on detrusor muscle and urinary sphincter function, several categories of prescription drugs can worsen LUTS,2,3 including antidepressants, antihistamines, bronchodilators, anticholinergics and sympathomimetics.4 By increasing urine volume, diuretics are also associated with LUTS.5,6 Because their prevalence of use rises with patient age, prescription drugs may contribute to the age-related increase in LUTS.7,8 Most previous research has focused on LUTS overall, without accounting for heterogeneity in etiology. If a significant proportion of LUTS can be attributed to medication use, the observed association between a suspected risk factor and LUTS could be attenuated. Thus, it is important to determine the magnitude of the association between medications and LUTS, and the degree to which LUTS may be attributed to these medications. To this end, this study assesses the cross-sectional association between current use of selected common medications and LUTS among men enrolled in the California Men's Health Study (CMHS).

Regular Nonsteroidal Anti-Inflammatory Drug Use and Erectile Dysfunction

Previous data suggest a potential relationship between inflammation and erectile dysfunction. If it is causal, nonsteroidal anti-inflammatory drug use should be inversely associated with erectile dysfunction. To this end we examined the association between nonsteroidal anti-inflammatory drug use and erectile dysfunction in a large, ethnically diverse cohort of men enrolled in the California Men's Health Study. This prospective cohort study enrolled male members of the Kaiser Permanente managed care plans who were 45 to 69 years old beginning in 2002. Erectile dysfunction was assessed by questionnaire. Nonsteroidal anti-inflammatory drug exposure was determined by automated pharmacy data and self-reported use. Of the 80,966 men in this study 47.4% were considered nonsteroidal anti-inflammatory drug users based on the definitions used and 29.3% reported moderate or severe erectile dysfunction. Nonsteroidal anti-inflammatory drug use and erectile dysfunction strongly correlated with age with regular drug use increasing from 34.5% in men at ages 45 to 49 years to 54.7% in men 60 to 69 years old with erectile dysfunction increasing from 13% to 42%. The unadjusted OR for the association of nonsteroidal anti-inflammatory drugs and erectile dysfunction was 2.40 (95% CI 2.27, 2.53). With adjustment for age, race/ethnicity, smoking status, diabetes mellitus, hypertension, hyperlipidemia, peripheral vascular disease, coronary artery disease and body mass index, a positive association persisted (adjusted OR 1.38). The association persisted when using a stricter definition of nonsteroidal anti-inflammatory drug exposure. These data suggest that regular nonsteroidal anti-inflammatory drug use is associated with erectile dysfunction beyond what would be expected due to age and comorbidity.

Red Wine Consumption Not Associated With Reduced Risk of Colorectal Cancer

Red wine contains polyphenol antioxidants that inhibit colorectal cancer (CRC) development in animal studies. We investigated the effect of red wine intake on risk of CRC in the California Men's Health Study (CMHS). CMHS is a prospective, multiethnic cohort of middle-aged men who were members of the Kaiser Permanente (KP) California Health Plans and completed study questionnaires between 2002–2003. Incident CRC were identified from the health plan cancer registries through the end of 2007 (n = 287). To properly account for potential confounding by previous endoscopy screening, we restricted the primary analyses to CMHS men continuously enrolled in KP between 1998–2002 (n = 43,483 and CRC = 176). We used multivariable Cox regression to adjust for important confounders. We did not find an inverse association between moderate red wine intake and risk of CRC. The hazard ratio for consuming ≥1 drink/day (average = 2 drinks/day) was 1.16, 95% confidence intervals 0.56–2.40. There was no linear dose-response. The lack of clear association for red wine intake was consistently observed when we stratified the analyses by CRC stage at diagnosis and cancer site (colon or rectum). Moderate red wine consumption was not associated with reduced risk of colorectal cancer in this population of middle-aged men.

Severity of diabetes and short-term risk of dementia in middle aged men: The California Men's Health Study

Severity of diabetes and short-term risk of dementia in middle aged men: The California Men's Health Study