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This study found that greater intake of dietary nitrate and green leafy vegetables was associated with a 20 percent to 30 percent lower risk of primary open-angle glaucoma (POAG), which is the most common form of glaucoma. Glaucoma can lead to vision loss and even blindness (if left untreated).There is evidence that nitric oxide has a role in primary open-angle glaucoma, and that dietary intake of nitrates is beneficial. Green leafy vegetables (iceberg lettuce, romaine lettuce,  mustard, or chard, cooked spinach, and raw spinach) were found to be most beneficial, as well as kale and collard greens. Those who ate the most green leafy vegetables ate about 1.5 servings per day, versus .3 servings daily in the lowest intake group.

Dietary nitrate is predominately derived from green leafy vegetables, which contribute approximately 80% of nitrate intake. But they are found as well in other vegetables, such as beets and carrots. It should be pointed out that those who consumed the most dietary nitrate in this study also consumed more fruits and vegetables, and so also consumed more dietary carotenoids, vitamin C, vitamin E, flavonoids, folate, and vitamin A. Bottom line: try to eat fruits and vegetables daily, especially green leafy vegetables (e.g., a salad). From Science Daily:

Higher dietary nitrate, green leafy vegetable intake associated with lower risk of glaucoma

Greater intake of dietary nitrate and green leafy vegetables was associated with a 20 percent to 30 percent lower risk of primary open-angle glaucoma, according to a study published online by JAMA Ophthalmology.

Elevated intraocular pressure and impaired autoregulation of optic nerve blood flow are implicated in primary open-angle glaucoma (POAG; optic nerve damage from multiple possible causes that is chronic and progresses over time). Evidence suggests that nitrate or nitrite, precursors for nitric oxide, is beneficial for blood circulation. Jae H. Kang, Sc.D., of Brigham & Women's Hospital and Harvard Medical School, Boston, and colleagues evaluated the association between dietary nitrate intake, derived mainly from green leafy vegetables, and POAG. The researchers followed up participants biennially in the prospective cohorts of the Nurses' Health Study (63,893 women; 1984-2012) and the Health Professionals Follow-up Study (41,094 men; 1986-2012). Eligible participants were 40 years or older, were free of POAG, and reported eye examinations. Information on diet was updated with questionnaires.

During follow-up, 1,483 incident cases of POAG were identified. Participants were divided into quintiles (one of five groups) of dietary nitrate intake (quintile 5, approximately 240 mg/d; quintile 1, approximately 80 mg/d). The researchers found that greater intake of dietary nitrate and green leafy vegetables was associated with a 20 percent to 30 percent lower POAG risk; the association was particularly strong (40 percent-50 percent lower risk) for POAG with early paracentral visual field loss (a subtype of POAG linked to dysfunction in blood flow autoregulation). 

Published on Leave a comment on Microbes Are Circling the Earth in Air Currents and Winds

The following article is interesting because it describes how microbes are high up in the sky riding air currents and winds to circle the earth, and eventually drop down somewhere. This is one way diseases can be spread from one part of the world to another. And the study looking at how antibiotic resistant bacteria are spread in the air from cattle feedlots has implications for how antibiotic resistance is spread. From Smithsonian:

Living Bacteria Are Riding Earth's Air Currents

Considering the prevailing winds, David J. Smith figured the air samples collected atop a dormant volcano in Oregon would be full of DNA signatures from dead microorganisms from Asia and the Pacific Ocean. He didn’t expect anything could survive the journey through the harsh upper atmosphere to the research station at the Mount Bachelor Observatory, at an elevation of 9,000 feet.

But when his team got to the lab with the samples, taken from two large dust plumes in the spring of 2011, they discovered a thriving bunch of hitchhikers. More than 27 percent of the bacterial samples and more than 47 percent of the fungal samples were still alive. Ultimately, the team detected about 2,100 species of microbes, including a type of Archea that had only previously been isolated off the coast of Japan. “In my mind, that was the smoking gun,“ Smith says. Asia, as he likes to say, had sneezed on North America.

 Microbes have been found in the skies since Darwin collected windswept dust aboard the H.M.S. Beagle 1,000 miles west of Africa in the 1830s. But technologies for DNA analysis, high-altitude collection and atmospheric modeling are giving scientists a new look at crowded life high above Earth. For instance, recent research suggests that microbes are hidden players in the atmosphere, making clouds, causing rain, spreading diseases between continents and maybe even changing climates.

"I regard the atmosphere as a highway, in the most literal sense of the term," Smith says. "It enables the exchange of microorganisms between ecosystems thousands of miles apart, and to me that’s a more profound ecological consequence we still have not fully wrapped our heads around."

Airborne microbes potentially have huge impacts on our planet. Some scientists attribute a 2001 foot-and-mouth outbreak in Britain to a giant storm in north Africa that carried dust and possibly spores of the animal disease thousands of miles north only a week before the first reported cases. Bluetongue virus, which infects domestic and wild animals, was once present only in Africa. But it's found now in Great Britain, likely the result of the prevailing winds.

In west Texas, researchers from Texas Tech University collected air samples upwind and downwind of ten cattle feedlots. Antibiotic resistant microbes were 4,000 percent more prevalent in the downwind samples. .... What's clear is there are far more viable microbes in far more inhospitable places than scientists expected.

Published on Leave a comment on Rethinking Cancer Screening

A provocative and thought-provoking article in which the title says it all: Cancer screening has not been shown to 'save lives'. The following is from the Medscape analysis/reporting of the original British Medical Journal article and accompanying editorial ( BMJ. January 2016, Article, Editorial), and both the original and Medscape analysis are well worth reading. From Medscape:

Cancer Screening Has Not Been Shown to 'Save Lives'

Debates about cancer screening programs tend to focus on when to start, who to screen, and the frequency of screening. But some investigators are asking a far more provocative question: Do screening programs actually save lives?

We do not know the answer to that question, and would need to conduct massive clinical trials to find out, said Vinay K. Prasad, MD, MPH, assistant professor of medicine at the Oregon Health Sciences University in Portland."Proponents of cancer screening say that screening tests have been shown to save lives. What we're trying to show is that, strictly speaking, that's sort of an overstatement," he told Medscape Medical News.

In an analysis published online January 6 in the BMJ, Dr Prasad and his colleagues argue that although cancer screening might reduce cancer-specific mortality, it has not conclusively been shown to have an effect on overall mortality. The researchers go on to suggest that the harms of screening might actually contribute to overall mortality rates. These potential harms include false-positive results that lead to unnecessary biopsies or therapeutic interventions and overdiagnosis, in which treatment is delivered for a condition that is unlikely to affect patients during their natural lifespans.

"There are two chief reasons why cancer screening might reduce disease-specific mortality without significantly reducing overall mortality," the researchers write. "Firstly, studies may be underpowered to detect a small overall mortality benefit. Secondly, disease-specific mortality reductions may be offset by deaths due to the downstream effects of screening." "The bar to say that screening saves lives should be overall mortality, and we haven't met that bar," Dr Prasad told Medscape Medical News.

The rationale for cancer screening is based on the assumptions that screening will reduce deaths from cancer and that lowering cancer-specific deaths will decrease overall mortality. These assumptions remain unsupported by facts, Dr Prasad's team contends.

They illustrate this point with data from the National Lung Cancer Screening Trial (NLST). Although there was a 20% relative reduction in lung cancer deaths with low-dose CT screening, compared with chest x-ray, and a 6.7% relative reduction in overall mortality, the absolute reduction in risk for overall mortality was just 0.46%....The team also notes that "the benefit in lung cancer mortality of CT screening (estimated to avert over 12,000 lung cancer deaths in the United States annually) must be set against the 27,034 major complications (such as lung collapse, heart attack, stroke, and death) that follow a positive screening test."

The decision to undergo screening should be part of an informed discussion between the patient and clinician that takes into account personal preferences and the risks and benefits of screening. Dr Prasad explained. "Declining screening may be a reasonable and prudent choice for many people," the researchers write. "Doctors should be comfortable with whatever choice people make when they hear about all the potential benefits and the known harms," Dr Prasad added.

However, in an accompanying editorial, Gerd Gigerenzer, PhD, from the Max Planck Institute for Human Development in Berlin, argues that "rather than pouring resources into 'megatrials' with a small chance of detecting a minimal overall mortality reduction, at the additional cost of harming large numbers of patients, we should invest in transparent information in the first place." He explains that information about screening should be presented in a "fact box" that lays out the benefits and risks of mammography with numbers for how many women would be affected."It is time to change communication about cancer screening from dodgy persuasion into something straightforward," he concludes.

Richard L. Schilsky, MD, chief medical officer for the American Society of Clinical Oncology (ASCO), said that although, in general, ASCO supports cancer screening, "it's a very imperfect process....The often high variability in the natural history of many cancers has been the source of particular confusion and uncertainty surrounding screening, he noted. For example, there is little value in screening for aggressive cancers for which interventions are unlikely to make a difference in outcomes, no matter how early the disease can be detected. Conversely, "if the cancer is never going to kill you, no matter what the doctors do, then screening won't help either," he said. Additionally, there are some cancers for which treatments are sufficiently effective that they can be successfully managed whether they are diagnosed at an early or later stage. "When you consider all these factors, the number of individuals who will actually benefit from detecting a screen-detected cancer is very small," Dr Schilsky said.

Published on Leave a comment on Phthalates, Sperm, and Miscarriages

More and more negative news about phthalates: men with greater exposure to DEHP (a phthalate) have lower sperm motility (how the sperm move or their ability to swim), and pregnant women with higher levels of phthalates have a higher rate of pregnancy loss (miscarriages - mainly between 5 and 13 weeks of pregnancy). Phthalates are found in many plastics, are thought to be endocrine disruptors, and can be measured in urine. From Medical Xpress: Lower sperm motility in men exposed to common chemical

Men with higher exposure to the substance DEHP, a so-called phthalate, have lower sperm motility and may therefore experience more difficulties conceiving children, according to a Lund University study. Phthalates is an umbrella term for a group of substances based on phthalic acid, some of which are suspected to be endocrine disruptors. Many phthalates are found in soft plastics in our daily surroundings.... Since phthalate molecules leak out of plastics, we are exposed to it daily and absorb the chemicals through food, drink, skin contact and inhalation. 

"We have studied metabolite levels of the phthalate DEHP (diethylhexyl phthalate) in urine as an indicator of exposure, as well as the semen quality of 300 men between the ages of 18 and 20. The results show that the higher metabolite levels the men had, the lower their sperm motility was", says Jonatan Axelsson, researcher at the Department of Laboratory Medicine, Lund University. For the one quarter of the men with the lowest levels of exposure, 57 per cent of the sperm cells were moving forward, compared to 46 per cent for the quarter of the men with the highest levels of exposure.

As previous research has reported that there is a linear connection also between sperm motility and chances of becoming pregnant, the findings could indicate that the more exposed one is to DEHP, the smaller the chances are of having children.

From Medical Xpress:  Exposure to phthalates could be linked to pregnancy loss

A new study of more than 300 women suggests that exposure to certain phthalates—substances commonly used in food packaging, personal-care and other everyday products—could be associated with miscarriage, mostly between 5 and 13 weeks of pregnancy. 

Out of concern over the potential health effects of phthalates, the U.S. has banned six of these substances from use in certain products made for young children. But many are still included as ingredients in paints, medical tubes, vinyl flooring, soaps, shampoos and other items. Research on phthalates has shown that long-term exposure to low levels of the some of these compounds harms lab animals' health and can increase their risk for pregnancy loss. Additionally, at least one study found that female factory workers exposed to high levels of phthalates through their work were at a higher risk for miscarriage.

The researchers tested urine samples from 132 women who had miscarriages and 172 healthy pregnant women in China. They found pregnancy loss was associated with higher levels of urinary phthalate metabolites from diethyl phthalate (DEP), di-isobutyl phthalate (DiBP) and di-n-butyl phthalate (DnBP). Although this doesn't prove that phthalates cause pregnancy loss, the study suggests an association exists that the researchers say should be studied further.

Published on Leave a comment on We Are Absorbing Some Air Pollutants Through Our Skin

When we think about air pollution, we usually think about pollutants in the air that we breathe in. But there is a growing body of evidence that some pollutants found in the air, including a group of chemicals called phthalates, can be absorbed directly through the skin (dermal absorption or dermal intake). A recent study has found that the skin absorption of certain phthalates (DERP and DnBP) is comparable to that from inhalation.

Phthalates are linked to a number of negative health effects, and so we should try to minimize our exposure to them.(Oct. 8, 2015 post and Sept. 29, 2015 post). The findings of this study is another strong argument against using scented products in the home, because phthalates are found in fragrances - whether air fresheners, scented candles, perfumes, dryer sheets, etc. Just think of them as indoor air pollution. From Environmental Health Perspectives:

Transdermal Uptake of Diethyl Phthalate and Di(n-butyl) Phthalate Directly from Air: Experimental Verification

Fundamental considerations indicate that, for certain phthalate esters, dermal absorption from air is an uptake pathway that is comparable to or greater than inhalation. Yet this pathway has not been experimentally evaluated and has been largely overlooked when assessing uptake of phthalate esters.This study investigated transdermal uptake, directly from air, of diethyl phthalate (DEP) and di(n-butyl) phthalate (DnBP) in humans.  ...continue reading "We Are Absorbing Some Air Pollutants Through Our Skin"

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We can't see them, but we all have little face mites that live in our faces, specifically in hair follicles. The scientific name of the face mites: Demodex folliculorum. There are at least 4 lineages of face mites that correspond to different regions of the world. Good thing they're harmless (we think).Gross but fascinating. From Wired:

Your Face Is Covered in Mites, and They’re Full of Secrets

WHEN YOU LOOK in the mirror, you’re not just looking at you—you’re looking at a whole mess of face mites. Yeah, you’ve got ‘em. Guaranteed. The little arachnids have a fondness for your skin, shoving their tubular bodies down your hair follicles, feeding on things like oil or skin cells or even bacteria. The good news is, they don’t do you any harm. The better news is, they’ve got fascinating secrets to tell about your ancestry.

New research out today in the Proceedings of the National Academy of Sciences reveals four distinct lineages of the face mite Demodex folliculorum that correspond to different regions of the world. African faces have genetically distinct African mites, Asian faces have Asian mites, and so too do Europeans and Latin Americans have their own varieties. Even if your family moved to a different continent long ago, your forebears passed down their brand of mites to their children, who themselves passed them on down the line.

Looking even farther back, the research also hints at how face mites hitchhiked on early humans out of Africa, evolving along with them into lineages specialized for certain groups of people around the planet. It seems we’ve had face mites for a long, long while, passing them back and forth between our family members and lovers with a kiss—and a little bit of face-to-face skin contact.

Leading the research was entomologist Michelle Trautwein of the California Academy of Sciences, who with her colleagues scraped people’s faces—hey, there are worse ways to make a living—then analyzed the DNA of all the mites they’d gathered. “We found four major lineages,” says Trautwein, “and the first three lineages were restricted to people of African, Asian, and Latin American ancestry.”

The fourth lineage, the European variety, is a bit different. It’s not restricted—it shows up in the three other groups of peoples. But Europeans tend to have only European mites, not picking up the mites of African, Asian, or Latin American folks. (It should be noted that the study didn’t delve into the face mites of all the world’s peoples. The researchers didn’t test populations like Aboriginal Australians, for instance, so there may be still more lineages beyond the four.)

So what’s going on here? Well, ever since Homo sapiens radiated out of Africa, those four groups of people have evolved in their isolation in obvious ways, like developing darker or lighter skin color. But more subtly, all manner of microorganisms have evolved right alongside humans. And with different skin types come different environments for tiny critters like mites.

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Published on 1 Comment on Physical Therapy Best For Carpal Tunnel Syndrome?

So many people I know complain of carpal tunnel syndrome, especially those who spend hours every day at a computer keyboard. Carpal tunnel syndrome is a hand and arm condition of numbness, pain, tingling, etc. caused by a pinched nerve in your wrist (pressure or compression of the median nerve). Treatments vary from physical therapy to steroids to surgery, with surgery being the recommended option by many doctors. So what is best?

A study with women randomly assigned to manual (physical) therapy or surgery suggests that from months one to 3 physical therapy was better and more effective, especially in pain relief. At the 6 months and one year follow-up, both groups were similar in outcome - in improvements in pain, symptoms, and functioning of the hands. What was nice in this study was that all assessments, baseline and follow-ups, were done by a blinded assessor - that is, a person who did not know what treatment was used on the patient.  Bottom line: a major intervention (surgery) may be unnecessary. From Medical Xpress:

PT beats surgery for quick relief of carpal tunnel pain

For women with carpal tunnel syndrome (CTS), physical manual therapies are similarly effective to surgery in the medium and long term, and may be more effective in the short term, according to a study published in the November issue of The Journal of Pain.

César Fernández-de-las Peñas, P.T., Ph.D., from the Universidad Rey Juan Carlos in Madrid, and colleagues compared the effectiveness of surgery versus physical therapy consisting of manual therapies, including desensitization maneuvers, in CTS. The interventions were either three sessions of manual therapy (physical therapy group; 60 patients) or decompression/release of the carpal tunnel (surgical group; 60 patients).

The researchers found that 55 women in the physical therapy group and 56 in the surgery group completed follow-up at 12 months. In adjusted analyses there was an advantage for the physical therapy group at one and three months in mean pain, the worst pain, and function. At six and 12 months, the changes in pain and function were similar between the groups. At all follow-ups the two groups had similar improvements in the symptoms severity subscale of the Boston Carpal Tunnel Questionnaire.

"This study found that surgery and physical manual therapies, including desensitization maneuvers of the central nervous system, were similarly effective at medium-term and long-term follow-ups for improving pain and function, but that physical therapy led to better outcomes in the short term," the authors write.

Published on Leave a comment on Appendicitis in Children Can Be Treated With Antibiotics
Drawing of colon seen from front (appendix is colored red). Credit: Wikipedia

This is the second time I've seen research finding that antibiotics  alone could be used (instead of surgery) for the treatment of uncomplicated appendicitis (June 17, 2015 post), but this time in children. Appendicitis is inflammation of the appendix.  At the one year follow-up the researchers found that 75.7% of patients with uncomplicated appendicitis had been successfully treated with antibiotics alone and had not had any recurrences of appendicitis.

This is a major finding because for years the gold standard for appendicitis treatment has been an appendectomy. The times are a changing.

From Science Daily: Antibiotics alone can be a safe, effective treatment for children with appendicitis

Using antibiotics alone to treat children with uncomplicated acute appendicitis is a reasonable alternative to surgery when chosen by the family. A study led by researchers at Nationwide Children's Hospital found that three out of four children with uncomplicated appendicitis have been successfully treated with antibiotics alone at one year follow-up. Compared to urgent appendectomy, non-operative management was associated with less recovery time, lower health costs and no difference in the rate of complications at one year.

"Surgery has long been the 'gold standard' of care for treating appendicitis because by removing the appendix we eliminate the chance that the appendicitis will ever come back," said Dr. Deans. "However, early in our careers we noticed that patients with appendicitis who were placed on antibiotics overnight until their surgery the following morning felt better the next day. So, Pete and I asked ourselves: do they really need to have surgery?"

In the first study conducted and published in the United States examining non-operative management for appendicitis, they enrolled 102 patients age 7 to 17 who were diagnosed with uncomplicated acute appendicitis at Nationwide Children's between October 2012 and October 2013. Participants had early/mild appendicitis, meaning that they experienced abdominal pain for no more than 48 hours; had a white blood cell count below 18,000; underwent an ultrasound or CT scan to rule out rupture and to verify that their appendix was 1.1 centimeter thick or smaller; and had no evidence of an abscess or fecalith, which is hard stone-like piece of stool.

Thirty-seven families chose antibiotics alone and 65 opted for surgery. Those patients in the non-operative group were admitted to the hospital and received IV antibiotics for at least 24 hours, followed by oral antibiotics after discharge for a total of 10 days. Among those patients, 95% showed improvement within 24 hours and were discharged without undergoing surgery. Rates of appendicitis-related medical care within 30 days were similar between the groups with two patients in the non-operative group readmitted within 30 days for an appendectomy. At one year after discharge, three out of four patients in the non-operative group did not have appendicitis again and have not undergone surgery.

Appendicitis, caused by a bacterial infection in the appendix, is the most common reason for emergency abdominal surgery in children, sending more than 70,000 young people to the operating room each year. Although many of these cases are severe and require surgery, there are a good number that would be candidates for treatment with antibiotics alone, Dr. Minneci said.

According to the study results, patients who were transferred to Nationwide Children's from other institutions expressed concerns about the distance and time necessary to come back if the appendicitis recurred. These families opted for surgery more often. Patients whose families spoke primary languages other than English were more likely to choose antibiotics as a course of treatment due to cultural values to avoid surgery if at all possible.

Published on Leave a comment on Endocrine Disrupting Chemicals and Male Infertility

Recent research looked at environmental causes of male infertility, specifically endocrine-disrupting chemicals. Poor semen quality contributes to increases in infertility and the use of assisted reproductive technology.The researchers also discuss the higher incidence of testicular cancer worldwide, lower levels of testosterone in men, and poor semen quality among men aged 20 to 25 (with the average man having up to 90% abnormal sperm). From Science Daily:

Endocrine-disrupting chemicals may be threatening fertility in industrialized countries

The birth rate is declining in all industrialised countries, and socioeconomic factors and women's age are not solely to blame. Male reproductive health and environmental factors are also significant, as concluded in a new scientific review article. ...Behind the article are fertility researchers from Denmark, the US and Finland. The researchers studied a number of factors related to fertility, and one of the main conclusions of their study was that poor semen quality contributed to increases in infertility and the use of assisted reproductive technology.

The study also revealed higher incidence of testicular cancer worldwide, with the greatest frequency among Caucasian populations. Moreover, the researchers also observed lower levels of testosterone in average men. "I was surprised that we found such poor semen quality among young men aged 20 to 25. The average man had up to 90% of abnormal sperm. Normally, there would be so many sperms that a few abnormal ones would not affect fertility. However, it appears that we are at a tipping point in industrialised countries where poor semen quality is so widespread that we must suspect that it results in low pregnancy rates," said first author of the article, Professor Niels E. Skakkebaek from the Department of Growth and Reproduction (EDMaRC) at Rigshospitalet and the University of Copenhagen.

"The article also demonstrates the impact of the increasing number of male reproductive problems on low birth rates. There is no doubt that environmental factors are playing a role. These are the correlations we are researching at the new research centre EDMaRC at Rigshospitalet," added Professor Anders Juul, who is the last author of the article.

Many of the male reproductive problems could be due to damage to the testes during embryonic development. While the reproductive problems could arise from genetic changes, "recent evidence suggests that most often they are related to environmental exposures of the fetal testes," the researcher team wrote."Since the disorders in male genitals have increased over a relatively short period of time, genetics alone cannot explain this development. There is no doubt that environmental factors are playing a role and that endocrine-disrupting chemicals, which have the same effect on animals, are under great suspicion. The exposure that young people are subjected to today can determine not only their own, but also their children's, ability to procreate," explained Professor Skakkebaek.

Published on Leave a comment on Male Infertility Linked to Other Chronic Medical Conditions

A recent study found that men with infertility have a much higher risk for a variety of other chronic medical conditions, including diabetes, heart disease, renal disease, alcohol abuse, and drug abuse. Thus, it appears that male infertility may be a symptom or a clue that there may be other health problems. One example is that male infertility is linked to an 81% greater risk of diabetes, and the greatest risk for renal disease occurred among men with azoospermia (zero sperm counts, the most severe form of male infertility). From Medscape:

Infertility in Men Tied to Heart Disease, Chronic Conditions

Men with infertility have a higher risk for a variety of other chronic medical conditions, including diabetes, heart disease, alcohol abuse, and drug abuse, according to a retrospective cohort study published online December 7 in Fertility and Sterility."The results suggest that male factor infertility has more than just reproductive implications," write Michael Eisenberg, MD, assistant professor of urology and director of male reproductive medicine and surgery at Stanford University School of Medicine in California, and colleagues.

The researchers used insurance claims data from 2001 to 2008 from the Truven Health MarketScan to identify more than 115,000 patients for the study population. They compared outcomes among 13,027 men diagnosed with male factor infertility (average age, 33 years), with outcomes among 23,860 men (average age, 33 years) who received semen or infertility testing and with outcomes among 79,099 men who had received vasectomies.

The authors looked for 16 conditions: hypertension, diabetes, hyperlipidemia, renal disease, chronic pulmonary disease, liver disease, depression, peripheral vascular disease, cerebrovascular disease, ischemic heart disease, other heart disease, injury, alcohol abuse, drug abuse, anxiety disorders, and bipolar disorder.

The men with infertility had higher rates of obesity and smoking, but even after adjustment for these covariates and for age, follow-up time, and healthcare use, men with infertility had a higher risk for multiple conditions compared with vasectomized men or those receiving only fertility testing. Specifically, compared with the men who received fertility testing, men with infertility had a 30% increased risk for diabetes (hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.10 - 1.53), a 48% increased risk for ischemic heart disease (HR, 1.48; 95% CI, 1.19 - 1.84) and for alcohol abuse (95% CI, 1.07 - 2.05), a 67% increased risk for drug abuse (HR, 1.67; 95% CI, 1.06 - 2.63), and a 19% increased risk for depression (HR, 1.19; 95% CI, 1.04 - 1.36).

Compared with men who received vasectomies, those with infertility had a 9% higher risk for hypertension (HR, 1.09; 95% CI, 1.02 - 1.17), a 14% greater risk for hyperlipidemia (HR, 1.14; 95% CI, 1.07 - 1.22), a 41% greater risk for ischemic heart disease (HR, 1.41; 95% CI, 1.19-1.67), and a 16% greater risk for other heart disease (HR, 1.16; 95% CI, 1.04 - 1.29). Further, men with infertility, compared with vasectomized men, had an 81% greater risk for diabetes (HR, 1.81; 95% CI, 1.57 - 2.08), a 60% greater risk for renal disease (HR, 1.60; 95% CI, 1.14 - 2.24), a 53% greater risk for liver disease (HR, 1.53; 95% CI, 1.31 - 1.80), and a 52% greater risk for peripheral vascular disorders (HR, 1.52; 95% CI, 1.12 - 2.07).