Study Links Fatty Liver And Heart Failure In Obese People

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newsFatty liver is independently associated with subclinical heart failure in obese people, according to a new study published online, January 26, in the journal Radiology. The findings add more support to the importance of dietary interventions in such patients, researchers said.

Fatty liver is independently associated with subclinical heart failure in obese people, according to a new study published online in the journal Radiology. The findings add more support to the importance of dietary interventions in such patients, researchers said.

Non-alcoholic fatty liver disease (NAFLD), also known as hepatic steatosis, is the most common liver disease, with a prevalence of up to 30 percent in the general population and between 70 percent and 90 percent among persons who are obese or have type 2 diabetes. NAFLD is considered as a manifestation of the metabolic syndrome, a group of risk factors like high blood pressure, excess abdominal fat and unhealthy cholesterol levels that raise the risk of heart attacks, strokes and other health problems.

“One of the unique aspects of our study is that we took all of the individual components of the metabolic syndrome into account as possible confounders in this association, as the metabolic syndrome is associated with NAFLD and with cardiovascular disease,” said study lead author Ralph L. Widya, M.D., from the Leiden University Medical Center in Leiden, the Netherlands.

For the study, Dr. Widya and colleagues used proton magnetic resonance spectroscopy to noninvasively measure hepatic triglyceride content, a measure of fat in the liver, and cardiac MRI to assess left ventricular diastolic function in 714 men and women aged 45 to 65 years. Of the 714 patients, 47 percent were categorized as overweight, and 13 percent were classified as obese.

The left ventricle is the heart’s main pumping chamber, and diastolic function refers to the phase of the heartbeat when the heart relaxes to fill with blood. Abnormalities of diastolic function, represented by inefficient filling of the heart, play a major role in exercise intolerance in patients presenting with heart failure. Diastolic dysfunction has been clinically undervalued and is currently gaining major attention by cardiologists and general physicians, according to senior author Hildo J. Lamb, M.D., Ph.D., also from Leiden University Medical Center.

Results indicated that an increase in hepatic triglyceride content was associated with a decrease in mean left ventricular diastolic function in the obese subgroup of the study population. The association between hepatic triglyceride content and left ventricular diastolic function existed independently of the metabolic syndrome, suggesting that fatty liver itself could, at least in obese people, pose a risk of heart dysfunction above and beyond known cardiovascular risk factors that are clustered within the metabolic syndrome.

“Our results may be of importance in cardiovascular risk stratification in obesity, because there is a large variation in the degree of hepatic steatosis in obesity,” Dr. Widya said. “Also, more emphasis should be put on dietary interventions to reduce or prevent hepatic steatosis.”

The reasons for the link between fatty liver and heart function are unknown, Dr. Widya said, but could be related to several factors, including the presence of infection-fighting white bloods cells called macrophages or increased expression in the liver of small proteins known as cytokines.

Future research is required to study the effect of NAFLD on cardiovascular events, according to Drs. Widya and Lamb, and further study is needed to investigate to what extent the association exists and differs among normal weight, overweight and obese persons.

New Study Links Endometriosis To Higher Risk Of Heart Disease

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By Tamer Seckin, MD

didyouknow?A new study out today is linking endometriosis to a higher risk of heart disease, particularly among women aged 40 years and under. The data shows that women in this age bracket are three times more likely to develop heart attack, chest pain or blocked arteries when compared to those without endometriosis of the same age. “This should be of real concern to doctor’s treating patients with endometriosis,” said Dr. Tamer Seckin, one of a handful of gynecologic surgeons in the United States who performs deep excision of endometriosis and is the founder of the Endometriosis Foundation of America (EFA) with Padma Lakshmi.

The study, published today in the Circulation: Cardiovascular Quality and Outcomes, an American Heart Association Journal, looked at the heart risk for women with endometriosis over a 20-year period. The study followed 120,000 women, of which about nearly 12,000 had endometriosis, and found that compared to women without endometriosis women with endometriosis were 1.35 times more likely to need surgery or stenting to open blocked arteries, 1.52 times more likely to have a heart attack and nearly two times as likely to develop angina.

“Studies on endometriosis are greatly needed, and I am pleased to see this research supported by the National Institute of Health,” said Seckin. Dr. Stacey Missmer, director of epidemiologic research and reproductive medicine at Brigham’s Women’s Hospital, who co-authored the study, spoke last year at the EFA’s 6th annual medical conference held in New York City.

According to the study, researchers noted that surgical treatment of endometriosis including the removal of the uterus and ovaries possibly accounts for the higher risk of heart disease. Seckin says this has been suspected for some time and is not a surprise to him. The study also reported that surgically induced menopause before natural menopause may also be an added risk.

The peer-reviewed paper also says that there is a specific and meaningful correlation between endometriosis and coronary heart disease. Seckin believes this may be due to the confounding systemic inflammation and chronic stress and pain.

Dr. Seckin urges that removal of the uterus and/or ovaries is not the optimal treatment for women with endometriosis. That is why he opts for deep excision surgery. Excision allows the surgeon to safely and successfully remove the disease and the inflammatory tissues.

“Deep excision surgery is about removing the endometriosis tissue from the body and preserving both the reproductive organs, and any other organs affected by the disease, as endometriosis often grows outside the reproductive tract in places like the bowel and colon,” said Seckin. “Treatment should offer a woman the best chance to regain a pain-free life, lessen long-term side effects from alternative therapies used to treat symptoms, and provide an opportunity for her to have children.”

Alternative therapies can include the use of oral contraceptives, hormone replacement therapy and painkillers for treating patients with endometriosis. The study did account for oral contraceptive and hormone replacement exposure but could not evaluate details of other hormonal treatments or the use of painkillers.

While he is busy advocating that the reproductive organs not be removed during endometriosis treatment, Seckin also expresses concerns about the dangers of long-term usage of hormones and pain medications. “These therapies have their risks,” he added.“Whether-or-not heart disease is one of these dangers, or the disease itself is the cause has still to be determined, but this study tells us something is increasing the risk for heart disease in women with endometriosis.”

Seckin said that the study convinces him that removing the disease through minimally invasive surgery gives women the most relief from their symptoms and does not expose them to side-effects that could put their overall health at risk.

– Tamer Seckin, MD, is an endometriosis specialist and surgeon in private practice in New York at Lenox Hill Hospital. He is the founder of the Endometriosis Foundation of America (EFA) with Padma Lakshmi. The EFA mission is to increase disease recognition, provide advocacy, facilitate expert surgical training, and fund landmark endometriosis research. Dr. Seckin is the author of “The Doctor Will See You Now; Recognizing and Treating Endometriosis” published March 2016 by Turner Publishing.

Hitting The Links Without Back Pain

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golfballSpine expert Dr. Kaixuan Liu with Atlantic Spine Center explains top 3 golfing-related back injuries and offers tips to prevent and treat them.

The perennially popular sport of golf often comes with a high price tag on players’ lower backs as well as their wallets. But hitting the links doesn’t have to lead to back injuries if golfers take the right preventive measures, according to Kaixuan Liu, MD, PhD, founder and president of Atlantic Spine Center.

Research has repeatedly shown that the lower back is the most common site of injury among golfers. A 2007 study in the Journal of Chiropractic Medicine indicated that 15% to 34% of amateur golfers have suffered lower-back injuries, with more men sustaining these injuries than women. Indeed, the lower back accounted for 25% of all golf-related injuries over the previous year among study participants, more than any other body region.

“While golf is perceived as a low-risk sport, that’s certainly not the case when it comes to the lower back,” says Dr. Liu, who is fellowship-trained in minimally invasive spine surgery. “But the lower back is rarely the cause of the pain from golfing. Typically, abnormal movements or forces by other body parts force the back to do more than its share of work, overusing and abusing it until an injury occurs.”

Top 3 golfing-related back injuries

What are the most common golf-related back injuries? Dr. Liu explains the top 3:

* Muscle strains and sprains: These back injuries are usually mild and resolve within 2 to 4 weeks with rest, Dr. Liu says. But lingering muscle stiffness or range-of-motion problems can make it difficult to hit the links again quickly.

* Disc injury: In the spine, discs between the vertebrae act as shock absorbers to help the spine cope with compressive forces. The powerful rotation and extension motion required to swing a golf club – especially when done incorrectly – can tear these discs, resulting in dysfunction and pain in the lower back and legs.

* Degenerative arthritis: Like all joints, those in the lower back can be damaged and worn down by wear and tear, which is known as degenerative arthritis. Since the back often does the lion’s share of work swinging a golf club, Dr. Liu says, this problem can occur more frequently there.

Preventing and treating golf-related back problems

Since prevention is always better than the best cure, stopping back injuries before they start is the optimal strategy, Dr. Liu says. He offers these tips to avoid golf-related back problems:

* Warm up first: Getting to the tee, pulling out your driver and hitting the ball full-blast without warming up first is simply a bad idea, Dr. Liu says. Warm up before a round by slowly stretching the torso, shoulder and hip regions, as well as your hamstrings. One survey showed that more than 8 in 10 golfers spent less than 10 minutes warming up before a round, according to the American Orthopaedic Society for Sports Medicine (AOSSM).

* Don’t carry your own bag: Golf is already a pricey sport, but shell out a little more cash for a caddy, or use a golf cart to tote your clubs, Dr. Liu advises. Golfers who carry their own bags have twice the incidence of back, shoulder and ankle injuries as those who don’t, according to the AAOSM.

* Get help with your swing: Hiring a golf pro, even for a short consultation, is a smart move to prevent golf-related back injuries, Dr. Liu notes. “Golfers should aim for a smooth, rhythmic swing, since this results in less stress on the lower spine and fewer back injuries,” he says. “Sometimes, however, golfers can’t achieve a balanced swing on their own and need a golf pro to tweak their technique.”

Most lower back injuries resulting from golfing will feel better over a few days to a few weeks, Dr. Liu says. Self-treatment measures can include rest; heat and/or ice on the aching area; and anti-inflammatory over-the-counter pain relievers such as ibuprofen or naproxen. If pain or stiffness does not resolve after a few weeks, it’s time to visit a spine physician to determine what other treatment may be needed.

“Try to avoid playing golf again just after a lower back injury occurs – which is difficult advice for die-hard golfers,” Dr. Liu says. “After back pain subsides, take it slow and make sure to use preventive measures to stop another lower back injury from ruining your golf game.”

Atlantic Spine Center is a nationally recognized leader for endoscopic spine surgery with several locations in NJ and NYC.,

Kaixuan Liu, MD, is a board-certified physician who is fellowship-trained in minimally invasive spine surgery at Atlantic Spine Center.