Men at forty something.

Forty-two? Forty-three? Forty-four? Don't ask me when it begins. I'm not at all sure. But I do know that middle age is an imminent reality for me and my friends. The baby boomers aren't babies anymore. We may still attend the young men's Bible class at church, but we're compelled to observe that most of the other members have more (or darker) hair, less-prominent wrinkles, and far fewer candles on the birthday cake then we.

Not that we're complaining. Many of us are enjoying good health, vigorously pursuing our chosen careers, and taking advantage of social and recreational opportunities afforded by the "empty nest." In fact, we hardly realize that middle age has overtaken us.

And therein lies the danger. As we engage the middle years of life, we should take a personal health inventory--to consider the current status of our physical well-being, and to plan for the near and distant future. Men are often neglectful, even irresponsible, in this regard.

Particular health concerns. Men understand the need for changing the car's oil and filter on a regular basis, and we're careful to purchase new tires before the treads become paper-thin, but our attitude toward our bodies is too often one of benign neglect. "Don't fix what ain't broke" is perhaps sound advice in some circumstances, but not for our bodies in middle age.

What health issues have particular relevance for men at mid-life? What constitutes a reliable preventive checkup? And what can we do to contribute to our good health?

Mortality statistics may seem a drab way to address the issue of men at mid-life. But the diseases and conditions responsible for the deaths of middle-aged men are also responsible for much disability and lack of well-being.

The two leading causes of death for men over the age of 35 are heart disease and cancer, accounting for 40 percent of deaths between ages 35 and 54, and well over half of all deaths in later years. Accidents, suicide, and HIV infection round out the top five in mid-life, whereas emphysema, strokes, and pneumonia achieve more prominence following age 55.

Heart disease includes many different conditions related to the heart, but the single most significant one in terms of death and disability is coronary artery disease (CAD). Caused by blockage of the arteries supplying oxygen and nutrients to the heart muscle, CAD is responsible for heart attacks that may result in sudden death or lifelong disability. Although the frequency of death from CAD has declined in recent years, it remains the most common (and perhaps the most preventable) cause of premature death.

Lung cancer is the most common cause of cancer death in men over 35, by a considerable margin. Cancer of the colon and rectum is a distant second, with cancer of the prostate pushing it back to third in the elderly male population.

According to Maureen Mylander, in her book The Healthy Male, men die in accidents at almost three times the rate of women. Half of all accidental deaths involve motor vehicles, and half of all motor vehicle fatalities involve alcohol. Men are also more likely to indulge in risky behaviors, and far more likely than women to die from drowning or firearm-related causes.

Suicide is the fourth-leading cause of death in men aged 35 to 54. Predictable patterns of stressors leading up to suicide fall into three areas: conflict/separation/rejection, economic problems, and medical illness (American Journal of Psychiatry, April 1991).

HIV infection or AIDS is now the fifth-leading cause of death in middle-aged males. This insidious and devastating viral disease is largely transmitted by intravenous drug abuse and risky sexual practices, including male homosexuality and sexual promiscuity.

While strokes and emphysema do not move into the top five causes of death in men until later decades, the seeds that subsequently yield their deadly harvest are sown in youth and mid-life.

Known risk factors. The known risk factors for serious preventable disease are relatively few and tend to have crossover impact. For example, cigarette smoking is a major risk factor for coronary artery disease, lung cancer, and emphysema. Likewise, hypertension is linked to both stroke and coronary artery disease. Following a diet low in fat and cholesterol and maintaining a desirable weight are integral to the prevention or control of heart disease and diabetes.

Here are a few simple, straightforward objectives for a healthy lifestyle for men at mid-life.

1. No smoking! No smoking! No smoking! No smoking ! 2. Adopt a healthful diet. The American Cancer Society Guidelines on Diet, Nutrition, and Cancer can be summed up in two words--variety and moderation. A varied diet is recommended, consisting of vegetables, fruits, and high-fiber foods such as whole-grain cereals and legumes, with limited consumption of fat and salt-cured, smoked, and nitrate-preserved foods.

3. Be physically active. Men who regularly engage in vigorous physical activity may substantially reduce the risk of heart attack, compared with their more inactive counterparts.

4. Maintain a desirable body weight. Obesity is a significant risk factor for heart disease and several types of cancer. Dietary moderation and regular physical activity are essential for optimum weight control.

5. Avoid the use and abuse of destructive substances. Tobacco, alcohol, caffeine, and illicit drugs have a range of deleterious effects on the body.

6. Adhere to responsible expressions of sexuality. Despite well-publicized ideas to the contrary, the safest form of sexual expression is the monogamous, heterosexual marriage relationship.

7. Schedule a regular preventive checkup with your primary-care physician. The United States Preventive Services Task Force defines regular as occurring every one to three years between 40 and 64 years of age. A routine health maintenance evaluation consists of a comprehensive history and physical examination with selected laboratory tests and procedures.

A routine physical. Every routine physical following age 40 should include a digital examination of the rectum for the detection of irregularities of the prostate gland and investigation for abnormal growths in the rectum. The American Cancer Society also recommends annual evaluation of the stool for occult blood after the age of 50 years. This is a simple, inexpensive test initiated at the time of the rectal exam.

A relatively new blood test, the prostate-specific antigen (PSA), along with the rectal examination has been shown to reveal more cases of prostate cancer than the rectal exam alone. Many urologists now recommend this test annually after age 50. Prostate ultrasonography may be recommended for individuals with abnormal findings.

Because of the well-documented relationship between elevated cholesterol and coronary artery disease, a serum cholesterol test should be performed at five-year intervals.

What about more sophisticated or expensive tests, such as sigmoidoscopy, chest X-ray, electrocardiogram, exercise stress testing, or comprehensive blood tests? Each of these tests may have a place in the routine health examination; however, their inclusion is somewhat more controversial, and many physicians would recommend one or more of these tests only for individuals considered to be at increased risk of associated disease.

Finally, good health for men at mid-life (and beyond) depends upon balance in the life. Physical, mental, social, and spiritual parameters combine to determine overall well-being. Warm family relationships, good friends, productive work, fulfilling recreational pursuits, and abiding trust in God provide direction and purpose and ultimate meaning to our lives.