MEN'S HEALTH MATTERS:The build-up of fat in the arteries is one of the leading killers in the western world, writes THOMAS LYNCH
Q I am 48 years old and recently had a health check. One of the things the doctor mentioned was my cholesterol because of a family history of heart disease. We hear about cholesterol all the time and I am not sure what it all means. What is cholesterol and why is it so important? How does it affect my heart?
A Cholesterol is a fat, which is a normal part of any diet and normal levels are needed in many animals and in man. High cholesterol levels, however, have been identified for over 50 years as likely to lead to a higher risk of heart attack, stroke and peripheral vascular disease (blockages in the legs).
It seems that when high levels of cholesterol have been present for many years, cells stuffed with fat become embedded in arteries in the heart and head. Over time, this deposition of fat will lead to blockages in these arteries, which in turn leads to heart attacks and/or stroke.
This type of build-up is one of the leading killers in the western world. Teenagers in western society start to build up “fatty streaks” in their major blood vessels, which will later lead to real problems.
The real issue is that “normal” cholesterol levels in the western world are, in historical and evolutionary terms, very high. The Bantu and Kalahari bushmen (with whom we share the same genetic make up) have cholesterol levels about half of what we would consider to be normal, and they have no coronary disease.
It would appear that our western diet has led to very high levels of cholesterol from a very early age. There is “bad” cholesterol, which is called low-density lipoprotein (LDL), as well as good cholesterol, high-density lipoprotein (HDL). It is the balance between the two which is important.
Cholesterol is one of the real treatable factors to help decrease the incidence of coronary disease. Strict diet alone can be very successful in lowering your levels of cholesterol and the key issue is to minimise your intake of animal fats such as butter and to eat a moderate amount of red meat.
Exercise is also very important. In the past 15 years, effective medications have become available which markedly reduce cholesterol. This has in turn been shown to reduce the risk of developing heart attacks and stroke.
Not everyone with high cholesterol is offered these tablets, as the aim is to treat those at highest risk (family history, smokers, high blood pressure, etc).
Q I am 35 years old and recently noticed blood in my semen. It was rather alarming, but it settled only to reappear a few weeks later. I do not have any other symptoms. I looked it up on the internet and am a little confused. Do I need to worry about it?
A Blood in the semen, also known as hematospermia, can be a very alarming symptom. However, bloody semen is almost never a sign of a serious underlying medical problem. In most cases, bleeding presumably follows damage to small blood vessels in the urinary tract or prostate gland. This may come from minor trauma or irritation, or growth of normal blood vessels. Small amounts of blood may linger in the semen for weeks, but almost all cases resolve on their own.
It’s very rare for bleeding to come from a serious cause such as cancer, and this is particularly true for men under 40. Young men who have a single episode of bleeding that goes away on its own generally need no evaluation other than an examination by your doctor and a urine specimen.
A more thorough work-up may be worthwhile in older men, or in men who have persistent or recurring episodes of bleeding. Such a work-up might include cystoscopy, which is an inspection of the bladder, an ultrasound of the bladder and prostate. However, most of these evaluations will be entirely normal.
In fact, even after extensive testing, it’s unusual for a specific cause of the bleeding to be identified. Possible rarer causes of blood in the semen include the following: urinary tract infections, prostatitis (inflammation of the prostate), sexually transmitted diseases such as gonorrhoea or chlamydia, benign prostate hyperplasia (benign non-cancerous enlargement of the prostate), surgical procedures such as prostate biopsy or bladder catheterisation (passing a tube into the bladder to drain urine), trauma to the testicles or prostate, cancer of the prostate, bladder or reproductive organs.
This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James’s Hospital, Dublin, with a contribution from Dr Ross Murphy, consultant cardiologist, St James’s Hospital.
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