Waist Size May Better Predict AFib Risk in Men

Sarah Amandolare wrote . . . . . . . . .

Body mass index may be more helpful in predicting the risk of a common type of irregular heartbeat in women, while waist size may better predict that risk in men, new research suggests.

The link between obesity and atrial fibrillation, or AFib – when the heart beats irregularly and often too fast – is well established. But researchers wanted to understand the extent to which body fat distribution might predict AFib risk among men and women.

The researchers analyzed BMI, waist circumference and electrocardiogram data gathered between 2008 and 2013 from more than 2 million older adults in the U.S. and United Kingdom who didn’t have cardiovascular conditions, including heart failure and stroke. The study’s lead author, Dr. Michiel Poorthuis of University Medical Center Utrecht in the Netherlands, described it as “probably the largest study of its kind to date.”

About 12,000 participants – 0.6% – had AFib. After adjusting for variables such as a history of high blood pressure, diabetes and smoking, the researchers found both higher BMI and a bigger waist were associated with an increased risk of AFib in men and women.

But there was a stronger connection between BMI and AFib risk among women, while waistline seemed a greater predictor in men. For women, adding BMI to the calculation improved the ability to predict AFib by 23% compared to a 12% improvement using waist size. In men, however, waist size came out on top, with a 30% improvement in predicting AFib versus 23% using BMI.

According to the National Heart, Lung, and Blood Institute, normal BMI is defined as below 25, and women with a waist size greater than 35 inches and men with a waist larger than 40 inches are at higher risk for heart disease and Type 2 diabetes.

Dr. Richard Bulbulia, co-senior author of the analysis published Thursday in the Journal of the American Heart Association, said the results bolster advice to maintain a healthy weight – and point to the next research question.

“What’s really exciting is the question of, can weight loss decrease atrial fibrillation burden in people who have it, or prevent people from developing it?” said Bulbulia, a research fellow in the University of Oxford Nuffield Department of Population Health and a consultant vascular surgeon at Cheltenham General Hospital in the United Kingdom.

The answer to that question could have broad repercussions: AFib, a major risk factor for stroke, is poised to affect an estimated 12.1 million Americans by 2030, according to American Heart Association statistics.

Left untreated, AFib doubles the risk of heart-related death and is associated with a fivefold higher risk of stroke. Some people with AFib have no symptoms, but others experience a rapid heartbeat or skipped beats.

Dr. Matthew Kalscheur, a clinical cardiologist and cardiac electrophysiologist at UW Health in Madison, Wisconsin, said the possible connection between waist circumference and AFib in men was important to consider.

Kalscheur, who was not involved in the new research, said although BMI – a standard measure of overweight and obesity – is routinely recorded and considered by clinicians in the context of AFib risk, waist circumference typically is not.

“The next step is, how do we present that to our patients, and how do we use this data to try to change behaviors that could impact that risk development,” Kalscheur said.

Like Bulbulia, Kalscheur wonders if, for instance, a person without AFib who is older, overweight and has high blood pressure can make behavioral changes to help prevent AFib – and, ideally, prevent stroke.

“We need to incorporate the results of studies like this one into the shared decision-making process that we have with our patients,” Kalscheur said. “In this case, it would be the shared decision about the importance of losing weight to reduce AFib risk.”

Source: American Heart Association

Structured Exercise Program, Not Testosterone Therapy Improved Men’s Artery Health

Twelve weeks of exercise training improved artery health and function in middle-aged and older men (ages 50-70 years) with low-to-normal testosterone levels, while testosterone therapy provided no benefits to the arteries, according to new research published in Hypertension, an American Heart Association journal.

The natural aging process for men includes decreased testosterone and physical activity levels decline with age, leading to declines in artery health and function. Testosterone replacement therapy is often used to combat the symptoms of decreasing testosterone levels, including low energy, reduced muscle mass and reduced vigor. In the absence of any new clinical indications, testosterone sales have increased 12-fold globally in the past decades.

“The global increase in testosterone use has been very large, particularly among middle-aged and older men who might see it as a restorative hormone to increase energy and vitality,” said study author Daniel J. Green, Ph.D., Winthrop Professor and cardiovascular exercise physiology researcher in the School of Human Sciences at The University of Western Australia in Perth, Australia. “However, previous studies are mixed as to whether replacement testosterone is beneficial or not, or whether it provides additional benefit over and above the effects of an exercise program.”

Green and colleagues evaluated men ages 50 to 70 years old, with no history of cardiovascular disease, higher than normal waist circumferences and testosterone levels that were in the low to normal range. The researchers also excluded current smokers, men currently on testosterone treatment or men on medications that would alter testosterone concentrations. At the beginning and end of the study, researchers measured artery function using a method that increases blood flow inside an artery. This assesses whether the inner lining of the artery is healthy and can help the artery to increase in size or dilate.

The 12-week study included 78 men randomized into four groups: 21 men received topical testosterone and completed a supervised exercise program including aerobic and strength exercises two to three times a week; 18 men received testosterone with no exercise; 20 men received a placebo and no exercise; and 19 men received a placebo with exercise. The exercise training was supervised in a research gymnasium at Fiona Stanley Hospital in Perth, and the program was overseen by an Accredited Exercise Physiologist (AEP).

The researchers found:

  • Testosterone treatment increased the levels of the hormone to above average levels in 62% of men in the groups that received the treatment.
  • Exercise training also increased testosterone level; however, the levels were highest among the men in the groups who received the testosterone supplement.
  • Artery function and health improved in the groups who received exercise training; but no improvement was found in those who received testosterone without exercise training.
  • Artery function in response to testing improved by 28% in the group who received exercise without testosterone, and by 19% in the group who received a combination of testosterone and exercise.

The researchers did not see changes in other tests that stimulated muscle cells in the middle of the artery wall, following exercise training, testosterone treatment or the combination of the two.

“The results of our study suggest that if you are a healthy but relatively inactive middle-aged or older man with increased abdominal girth, and you are worried about your risk of heart attack, stroke or diabetes, then an exercise program with some support and supervision can help to improve the function and health of your arteries,” Green said. “Testosterone therapy may have some benefits, for example in increasing muscle mass in the legs, however, we didn’t find any benefits in terms of artery function, which is a determinant of future cardiovascular risk.”

Green noted that the study’s small size is a limitation, and this research lays the foundation for larger studies that could lead to health recommendations for men.

Source: American Heart Association

Hormone Therapy No Cure-all for ‘Low T’ in Aging Men

Testosterone therapy ads promise to help aging men recapture their vitality, decrease body fat and enhance libido. But hormone treatments – while medically necessary for some men – aren’t meant to be a fountain of youth, and experts warn more research is needed to determine if such therapy could boost heart disease risks.

Testosterone levels naturally decline in most men as they age. This decline is generally mild, and symptoms often are nonspecific, such as low energy, reduced muscle mass and reduced vigor. Roughly 20% of men over the age of 60 have experienced a drop in testosterone levels, though this gradual decline can begin as early as the mid-30s.

While that can be frustrating, experts say it’s not a clinical indication of a need for testosterone therapy, nor is there any evidence that therapy is effective for treating those symptoms. The Food and Drug Administration has limited approval of testosterone therapy to the treatment of organic hypogonadism, a dramatic drop in testosterone caused by disease or injury of the hypothalamus, pituitary gland or the testes.

“If testosterone therapy is used appropriately in men with organic hypogonadism, then there is no controversy,” said Dr. Shehzad Basaria, associate director of Men’s Health: Aging and Metabolism at Brigham and Women’s Hospital in Boston. The condition causes specific symptoms such as decreased sexual desire, breast enlargement, testicular atrophy and hot flashes.

But “in middle-aged and aging men who have a slightly lower testosterone level and nonspecific symptoms due to aging or obesity, testosterone therapy is not indicated. Similarly, testosterone is not a rejuvenation drug,” said Basaria, an associate professor of medicine at Harvard Medical School. “The majority of patients seen in our clinics have symptoms such as fatigue, weight gain, muscle loss or feeling sad. These symptoms are common and nonspecific, and testosterone therapy is generally not indicated in such clinical scenarios.”

Over the past two decades, intense direct-to-consumer marketing of hormone therapy for aging men, much of it via television ads, has more than doubled its off-label use. It’s a trend experts warn is medically unwarranted and potentially harmful.

The American College of Physicians, which issued new guidelines in January, recommends against prescribing testosterone therapy to boost energy, vitality or physical function, but supports its use for men experiencing sexual dysfunction. The recommendation calls for discussing potential benefits and risks with the patient and discontinuing treatment after one year if there is no improvement.

“I think one of the biggest concerns about testosterone therapy is whether it is really needed,” said Dr. Robert Eckel, professor of medicine and an endocrinologist at the University of Colorado School of Medicine in Aurora, Colorado. “Erectile dysfunction is a common problem as men age, but there can be other reasons for this, such as vascular disease or nerve damage, which is more common in patients with diabetes. It is not necessarily an indication for treatment with testosterone therapy. The patient must be properly evaluated.”

The FDA warns against prescribing testosterone therapy for age-related hormonal decreases or anything other than a medical diagnosis of hypogonadism. Since 2015, it has required testosterone product labels to warn of a possible increased risk of heart attacks and stroke.

But research about that association so far is unclear, Basaria said.

“Some studies have reported higher cardiovascular risk with testosterone use but there are an equal number of studies showing that it does not increase cardiovascular risk,” he said. “This discrepancy exists because no study published to date has been powered to assess cardiovascular events as the primary outcome.”

Eckel, president of medicine and science for the American Diabetes Association and a past president of the American Heart Association, agreed. “The cardiovascular disease outcome story is not convincing one way or another. I think to make a strong statement here would be a mistake.”

Source: American Heart Association

What Works Best to Help Men with Overactive Bladder?

Steven Reinberg wrote . . . . . . . . .

Learning how to control the urge to urinate may be all the therapy men need to treat an overactive bladder, a new study suggests.

A combination of drugs and behavioral therapy seems to work better than drugs alone, but behavioral therapy alone also worked better than drugs, the researchers found.

The trial of 204 men with overactive bladder suggests behavioral therapy may be a good way to start treatment, the study authors said.

“The study provides good evidence that for the group of men with overactive bladder, symptoms without obstruction from an enlarged prostate can be successfully managed with behavioral therapy alone,” said Dr. Manish Vira, who was not involved with the study, but reviewed the findings. He’s vice chairman of urologic research at Northwell Health’s Arthur Smith Institute for Urology in Lake Success, N.Y.

Many medications typically prescribed for overactive bladder have significant side effects, especially in older men using multiple medications, Vira added.

For the trial, Kathryn Burgio, associate director of research at the Birmingham VA Medical Center in Alabama, and colleagues randomly assigned men to six weeks of behavioral therapy alone, drug therapy alone, or combined drug and behavioral therapy. After the initial six weeks, all of the men received combination therapy for another six weeks.

Behavioral therapy gave men pelvic floor muscle training along with techniques to suppress the urge to urinate and delay urinating.

The drugs prescribed included tolterodine (Detrol) and tamsulosin (Flomax). Like behavioral therapy, the treatment is covered by most insurance.

Symptoms of overactive bladder were reduced in all groups, the study found. Combination therapy reduced symptoms by 31%, behavioral therapy alone by 25%, and drugs alone by 13%.

Further analysis found combination therapy significantly lowered frequency of urination, compared with drug therapy, but not when compared with behavioral therapy alone.

After all the men had been on combination therapy, those who had been on drugs and behavioral therapy from the start had the greatest reduction in the frequency of urination, the findings showed.

“Although some clinicians advocate combined treatment, most do not integrate behavioral components, such as pelvic floor muscle training or delayed voiding, into standard therapy,” the authors concluded in their report. “Behavioral therapy can be implemented by nurses, nurse practitioners, and physical therapists and has the potential for widespread application in a variety of outpatient settings.”

Two Stanford University doctors said the findings confirm what urologists have advocated for more than a decade, and support American Urological Association treatment guidelines on management of overactive bladder.

“While patients may often request medication to address their symptoms, this study supports the recommendation to begin with behavioral therapy, or to combine pelvic floor exercises with medication, as they work better than medication alone,” Dr. Craig Comiter and Dr. Ekene Enemchukwu, assistant professors of urology, obstetrics and gynecology, said in a joint email. They were not involved with the study.

Starting with behavioral therapy can prevent side effects associated with overactive bladder medications, such as dry mouth, dry eyes, constipation, memory changes and drowsiness, they said.

If first-line treatment is not successful, medications may be added, Comiter and Enemchukwu suggested. Alternatively, behavioral therapy may be combined with medications immediately.

“There are very few instances where a patient should be treated with medication alone — even when he asks, ‘Can you just give me a pill to help my symptoms?’ The answer should be a resounding, ‘No,'” Comiter and Enemchukwu advised.

The report was published online in JAMA Internal Medicine.

Source: HealthDay

Today’s Comic

Men Who Eat Yogurt May Have Lower Colon Cancer Risk

Lisa Rapaport wrote . . . . . . . . .

Men who eat at least two servings a week of yogurt may be lowering their risk for colorectal cancer, a recent study suggests.

Researchers examined data on 32,606 male and 55,743 female health professionals who had a colonoscopy between 1986 and 2012. Study participants provided detailed information about their health, lifestyle, eating and exercise habits every four years.

Over that time, there were 5,811 cases of colorectal adenomas, or abnormal tissue that can sometimes become cancerous, in men and 8,116 adenomas in women.

Compared to men who didn’t eat any yogurt, those who had at least two servings weekly were 19 percent less likely to develop so-called conventional adenomas, the most common kind of polyps found in the colon and rectum during colonoscopies. The yogurt eaters were also 26 percent less likely to develop adenomas with the highest potential to turn into cancer.

“Our data provide novel evidence for the role of yogurt in the early stage of colorectal cancer development,” said study coauthor Dr. Yin Cao of Washington University School of Medicine in St. Louis.

“The findings, if confirmed by future studies, suggest that yogurt might serve as a widely acceptable modifiable factor, which could complement colorectal cancer screening and reduce risk of adenoma among the unscreened,” Cao said by email.

Yogurt consumption has been linked to a lower risk of colon and rectal cancer in previous studies, and some scientists think this may be because yogurt promotes the growth of healthy bacteria in the gut. But less is known about how yogurt might impact the potential for people to develop adenomas.

To minimize the risk of colorectal cancer, adults should start getting screened for these tumors at age 45, according to the American Cancer Society. Screening can catch tumors sooner, when they’re smaller and easier to treat, increasing survival odds.

Abnormal polyps can take 10 to 15 years to develop into colon cancer, and some adenomas found with screening may never become cancerous or prove fatal.

In the study, yogurt consumption didn’t appear to impact the risk of pre-cancerous polyps in women.

The study wasn’t designed to prove whether or how yogurt consumption might impact cancer risk. It also didn’t examine how many people with polyps went on to develop cancer.

“Much of the benefit from dairy products is thought to come from the calcium they provide, which we know can help prevent colon cancer,” said Dr. Graham Colditz, associate director for prevention and control at the Alvin J. Siteman Cancer Center in Saint Louis who wasn’t involved in the study.

“However, because this study took into account calcium intake, among other dietary factors, these results suggest that yogurt may be lowering risk though an avenue other than calcium,” Colditz said by email.

The probiotics in yogurt may be helping.

“Though it’s not clear that probiotics help lower colon cancer risk, there are a number of possible ways they could,” Colditz said. “Probiotics may help reduce inflammation – a cancer risk factor – as well as bind and neutralize certain carcinogens in the colon.”

People who want to add yogurt to their diet should focus on fat-free or low-fat options, said Vandana Sheth, owner of a Los Angeles based nutrition consulting practice. And they should also pay attention to their overall diet.

“Enjoy a diet filled with lots of vegetables, fruits and whole grains,” Sheth, who wasn’t involved in the study, said by email. “Limit red meat, especially processed meats like hot dogs and lunch meats, and limit alcohol.”

Source: Reuters

Today’s Comic