TV, Heart Disease & Fibroids – Why sitting still can be bad for your health
By Alicia Armeli

fibroids-tv

How much time do you spend in front of the TV? Reclining on the couch watching funny pet videos on your tablet? Sitting at your computer crunching numbers at work?  You get the picture. Even though being sedentary has become a commonplace of modern day living, it can take a huge toll on your arteries, says the Journal of Surgical Research1—which could prove even riskier if you’re a woman with fibroids.

In the study, five healthy young individuals (age 22 +/- 2 years) committed to five days of bed rest to mimic physical inactivity. By doing so, Nosova and colleagues hoped to see how even short periods of sedentary behavior could impact heart and blood vessel health.

Before, during, and two days following bed rest, different tests were performed to measure if physical inactivity compromised blood vessel function. Since high blood pressure and the presence of inflammatory biomarkers contribute to heart disease, these were also measured. Each person adhered to the same diet throughout the study.

The authors found that short-term physical inactivity, represented by bed rest, resulted in a decline in vascular function. Vessel elasticity or flexibility was replaced by an increase in arterial stiffness. Diastolic blood pressure increased (the pressure your arteries experience between beats when the heart is at rest) and an influx of an enzyme, 15-HETE, was also observed. How 15-HETE impacts blood vessel function isn’t entirely clear, but it could be linked to narrowing of the arteries, the authors suggested.

“Dysfunctional endothelium (cells that line blood vessels) has been recognized as an initial step in the development of atherosclerosis,” the authors wrote. “Our findings suggest that inactivity leads to quantifiable impairment in vascular function and arterial wall stiffening, and we speculate that these are a result of endothelial dysfunction.”

Atherosclerosis is the buildup of plaque in the arteries that could lead to a heart attack or stroke.3 As we age, the risk for atherosclerosis and heart disease increases. 4,5 Nosova and colleagues pointed out that if physical inactivity impacted young healthy individuals in such a way, older adults who are more likely to be sedentary could be at an even greater risk.

A paper2 published earlier this year in the Journal of the American College of Cardiology confirmed that older adults are also at risk. Instead of simulating physical inactivity, the authors observed 2,031 individuals enrolled in the Dallas Heart Study—62 percent of whom were women 50 +/- 10 years of age. Results showed that each hour of sedentary time was linked to a 14 percent increased risk of coronary artery calcification—an indication of atherosclerosis. All individuals studied were free of known cardiovascular disease.

And the stakes may only get higher if you’re a woman with fibroids. Sedentary behavior in itself is associated with uterine fibroids in premenopausal women6 and recent studies show that having fibroids may increase a woman’s risk for atherosclerosis.7

Physical inactivity has been referred to as “the leading cause of excessive and preventable cardiovascular risk.”1 So the next time you settle in to watch that movie marathon, remember what it could be doing to your health.

Read more for ways to get moving.

ABOUT THE AUTHOR   Alicia Armeli is a Health Freelance Writer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering with her local animal shelter.

REFERENCES

  1. Nosova, E. V., Yen, P., Chong, K. C., Alley, H. F., Stock, E. O., Quinn, A., Hellman, M. S., Conte, M. S., Owens, C. D., Spite, M., & Grenon, S. M. (2014). Short-term physical inactivity impairs vascular function. Journal of Surgical Research, 190(2): 672-682. doi:10.1016/j.jss.2014.02.001
  2. Kulinski, J., Kozlitina, J., Berry, J., de Lemos, J., & Khera, A. (2015). Sedentary behavior is associated with coronary artery calcification in the Dallas Heart Study. Journal of the American College of Cardiology, 65(10_S): doi. 10.1016/S0735-1097(15)61446-2
  3. American Heart Association. (2014). What is Cardiovascular Disease? Retrieved August 23, 2015, from http://www.heart.org/HEARTORG/Caregiver/Resources/WhatisCardiovascularDisease/What-is-Cardiovascular-Disease_UCM_301852_Article.jsp
  4. National Heart, Lung, and Blood Institute. (2014). Who Is at Risk for Atherosclerosis? Retrieved August 23, 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis/atrisk
  5. National Heart, Lung, and Blood Institute. (2014). What Are the Risk Factors for Heart Disease? Retrieved August 23, 2015, from http://www.nhlbi.nih.gov/health/educational/hearttruth/lower-risk/risk-factors.htm
  6. He, Y., Zeng, Q., Dong, S., Qin, L., Li, G., & Wang, P. (2013). Associations between uterine fibroids and lifestyles including diet, physical activity, and stress: a case-control study in China. Asia Pacific Journal of Clinical Nutrition, 22(1): 109-117. doi:10.6133/apjcn.2013.22.1.07
  7. Aksoy, Y., Sivri, N., Karaoz, B., Sayin, C., & Yetkin, E. (2014). Carotid intima-media thickness: a new marker of patients with uterine leiomyoma. European Journal of Obstetrics & Gynecology and Reproductive Biology, 175: 54-57. doi:10.1016/j.ejogrb.2014.01.005
Are Women With Fibroids at a Greater Risk for Heart Disease?
By Alicia Armeli

Heart-Disease

Heart disease is the leading cause of death among women in the United States.1  Although cardiovascular and reproductive health may seem unrelated, could having uterine fibroids put a woman at an even higher risk of heart attack or stroke? According to a recent study published in the European Journal of Obstetrics & Gynecology and Reproductive Biology2, Aksoy and a team of researchers found that these conditions may be more connected than we think.

The Turkish study conducted at the Cardiology and Gynecology & Obstetrics Clinics in Trakya University looked at 292 women diagnosed with fibroids and 185 women without. In both groups, blood samples were taken and a carotid intima-media thickness test was used to detect any early signs of atherosclerosis. Using sound waves, this non-invasive procedure provides physicians with a visual of the carotid artery—the large blood vessel that runs along both sides of the neck. This makes it possible to spot vascular disease.3

Results showed that women with fibroids had notably thicker arteries in comparison to those without. What’s more, women with fibroids were also seen to have lower HDL (the “good” cholesterol) levels. And according to the American Heart Association, both of these outcomes are associated with an increased risk of heart disease.4,5

Healthy blood vessels are flexible and are able to expand and contract with blood flow and pressure. But when arteries become clogged with plaque made from different circulating fats and calcium deposits, they can become narrow and stiff—as seen with atherosclerosis. This makes it difficult for oxygen-rich blood to reach our organs and can dangerously lead to heart attack and stroke.

But why are women with fibroids at a higher risk if the problem lies within the arteries? According to the authors, several possibilities exist.

Although not entirely understood, the authors first highlighted that women with fibroids are also at an increased risk for high blood pressure. When blood pressure is abnormally high, they explained, the cells that line artery walls can be injured2 and release inflammatory proteins6 that may increase plaque deposits. The Nurses’ Health Study II showed that with each 10 mmHg increase of diastolic blood pressure (the bottom number indicating pressure when the heart is at rest between beats), a women’s risk of uterine fibroids rises 8 percent.6

In this way, injury to uterine blood vessels may play a role in the development of fibroids. “Observed abnormalities in the structure and function of the uterine vasculature in the presence of uterine [fibroids] invite the possibility that direct injury (caused by atherosclerosis) to uterine blood vessels may play a role,” the authors explained.

The authors further pointed out that many similarities2 exist between plaque formation and uterine fibroid growth. Both conditions are thought to come from a single abnormal smooth muscle cell. And in order for either disease to thrive, the cell needs to multiply rapidly. When the body detects this abnormal growth—whether it is along blood vessel walls or in the uterus—it tries to contain the injury by laying down fibrous and calcified tissue. This process is ongoing and, depending on the location, may lead to thickened arteries or uterine fibroids.

In addition to vascular thickening and high blood pressure, other factors like obesity are linked to uterine fibroids. A study examining fibroids in Chinese women6 reported such results. “These factors are also common cardiovascular risks and might be related to atherosclerosis,” collaborative authors stressed. “These shared patterns support the hypothesis that the development of uterine fibroids and the development of plaques (from atherosclerosis) share a common biological mechanism.”

Finally, the HDL connection. HDL cholesterol is thought to protect against vascular disease, heart attack, and stroke because it carries other cholesterols that could potentially promote atherosclerosis from the arteries to be processed in the liver. Lower HDL levels may put an individual at an increased risk of heart disease5 and may be the reason in these studies for a heighted risk of atherosclerosis in women with fibroids.6

“These findings suggest that women with uterine [fibroids] may have an increased risk of subclinical atherosclerosis,” Aksoy concluded. “Cardiovascular diseases are among the most prevalent causes of…mortality in developed communities” but “classical cardiovascular risks have not been observed in nearly one-half of these diseases.” For this reason, it’s crucial that new risk factors—like uterine fibroids—be investigated early on to detect hidden signs of heart disease so women can be treated accordingly.

 

ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering with her local animal shelter.

REFERENCES

  1. United States Centers for Disease Control and Prevention. (2011). Leading Cause of Death by Race/Ethnicity, All Females-United States, 2011. Retrieved August 25, 2015, from http://www.cdc.gov/women/lcod/2011/WomenlRace_2011.pdf
  2. Aksoy, Y., Sivri, N., Karaoz, B., Sayin, C., & Yetkin, E. (2014). Carotid intima-media thickness: a new marker of patients with uterine leiomyoma. European Journal of Obstetrics & Gynecology and Reproductive Biology, 175: 54-57. doi:10.1016/j.ejogrb.2014.01.005
  3. Cedars-Sinai. (2015). Carotid Intima-Media Thickness Test. Retrieved August 26, 2015, from http://www.cedars-sinai.edu/Patients/Programs-and-Services/Womens-Heart-Center/Services/Carotid-Intima-Media-Thickness-Test.aspx
  4. American Heart Association. (2014). Atherosclerosis. Retrieved August 27, 2015, from http://www.heart.org/HEARTORG/Conditions/Cholesterol/WhyCholesterolMatters/Atherosclerosis_UCM_305564_Article.jsp
  5. American Heart Association. (2014). Good vs. Bad Cholesterol. Retrieved August 27, 2015, from http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/Good-vs-Bad-Cholesterol_UCM_305561_Article.jsp
  6. He, Y., Zeng, Q., Li, X., Liu, B., & Wang, P. (2013). The association between subclinical atherosclerosis and uterine fibroids. PLoS One, 8(2): e57089. doi: 10.1371/journal.pone.0057089
Improvements in UFE Pain Management Protocol
By Alicia Armeli

PainManagement

Advances in uterine fibroid embolization (UFE) patient care are happening every day—particularly in the area of pain management. Although considered minimally invasive, UFE is associated with some pain following the procedure. However, thanks to physicians like Cheryl Hoffman, MD, new protocols are being investigated to ensure patient comfort is a priority throughout all stages of UFE.

“The procedure itself is not painful,” says Dr. Hoffman, Health Sciences Associate Clinical Professor at the David Geffen School of Medicine at UCLA and Medical Director at the Manhattan Beach Radiology Imaging and Interventional Center. “Patients only feel a little poke in the groin, which is typically the same as getting a little numbing medicine in your mouth when you go to a dentist. We also give patients medicine to lessen their anxiety and to handle any discomfort.”

During UFE, a catheter is inserted through a small incision in the upper thigh. Using special imaging equipment, the catheter is threaded through the femoral artery in the leg and then into the uterine arteries. Small particles called embolics are injected in the uterine arteries to block the blood flow that feeds the fibroids, causing them to shrink and die.

“It’s at the end of the procedure after we have cut off the blood supply to the fibroids that the patients can have cramping and pelvic pain,” clarifies Dr. Hoffman. “That’s the pain we’re actively looking for the best formula to help control—toward the end of the procedure and for the initial hours afterward.”

Currently, pain protocol can differ but commonly includes a preemptive pain reliever, an anti-inflammatory medication, and an anti-nausea medication to help counteract the effect of the pain relievers.1 “There are a variety of protocols out there and we’re always striving to make it as comfortable as possible for patients,” Hoffman explains. “The regimens are usually based around narcotics and non-steroidal anti-inflammatory drugs (NSAIDs) with the hope of trying to control the pain after the procedure and any nausea associated with the medications.”

Since UFE’s inception in 19952, pain management protocols are always improving due to ongoing clinical trials. “Coming up with the right regimen and trying to figure out what works and what doesn’t is the key,” explains Dr. Hoffman, who is currently conducting her own UFE pain management trial.

“There are two new medications that fall within the category of controlling pain—IV Tylenol and IV Advil. They’ve been used internationally, frequently, and have been found to be safe but have never been applied to a placebo, double-blinded, randomly controlled UFE trial.”

Working alongside Jonathan S. Jahr, MD, anesthesiologist and Professor of Clinical Anesthesiology at the David Geffen School of Medicine at UCLA, Hoffman has high hopes for this study.

“When these drugs are used together, we’d like to see if there’s a synergistic effect and indeed control the pain more,” says Dr. Hoffman. “We’re comparing that to how much narcotics patients need, which can be associated with increased nausea. When these two drugs are used together, we’re trying to see if we use less narcotics and if we use less narcotics do we then have less nausea and use less anti-nausea medicines?”

Better pain management and improved patient care are significant, but Dr. Hoffman’s reasons for conducting the study encompass much more. By making UFE as comfortable as possible for women, she hopes to make uterus-sparing procedures more mainstream.

“Hysterectomy is an overused procedure and patients should not be getting the number of hysterectomies they’re getting. There are a lot of good things a uterus does besides make a baby,” Hoffman points out. “If a woman has symptomatic fibroids, we should be able to do something minimally invasive, but she shouldn’t have to have her whole uterus removed. Every physician should always be discussing all of a patient’s options.”

Dr. Hoffman’s study is listed on the US National Institutes of Health Clinical Trials website.

ABOUT THE AUTHOR Alicia Armeli has a Master of Science in Nutrition and Whole Foods Dietetics (MSN/DPD) and is a registered dietitian nutritionist, a certified dietitian, and a holistic life coach. In addition to writing, she enjoys singing, traveling abroad and volunteering with her local animal shelter.

ABOUT THE DOCTOR Cheryl Hoffman is a Health Sciences Associate Clinical Professor at the David Geffen School of Medicine at UCLA and Medical Director at the Manhattan Beach Radiology Imaging and Interventional Center. She is American Board Certified in Vascular and Interventional Radiology as well as Diagnostic Radiology. Through patient care and research, Dr. Hoffman builds public awareness around uterine fibroids and all treatment options available with the goal of helping women everywhere live optimally. For more information regarding the study, please contact Dr. Hoffman, MD at [email protected] 

REFERENCES

  1. Konstantatos, A. H., Kavnoudias, H., Stegeman, J. R., Boyd, D., Street, M., Bailey, M., Lyon, S. M., & Thomson, K. R. (2014). A randomized, double-blind, placebo-controlled study of preemptive oral oxycodone with morphine patient-controlled anesthesia for postoperative pain management in patients undergoing uterine artery embolization for symptomatic uterine fibroids. Cardiovascular and Interventional Radiology, 37(5): 1191-1197. doi: 10.1007/s00270-014-0913-2.
  2. Ravina, J. H., Herbreteau, D., Ciraru-Vigneron, Bouret, J. M., Houdart, E., Aymard, A., & Merland, J. J. (1995). Arterial embolisation to treat uterine myomata. Lancet, 346(8976): 671–672.
Some women suffer in silence. But not Renee Brown Small.
By Alicia Armeli

renee_brown_hires

In 2006, Renee visited her gynecologist. With a slightly protruding belly, she wondered if she might be pregnant. “‘Either you’re pregnant or have fibroids,'” Renee Brown Small, Co-founder and CEO of The Fibroids Project recalled her gynecologist saying. Renee wasn’t pregnant but, at the time, she was also not familiar with fibroids—the source of her symptoms. Little did she know her diagnosis set the stage for the conception of an international fibroid organization that would be trusted by women everywhere.

Fibroids are common benign tumors that grow in the uterine wall and affect 20-80 percent of women. According to the US Department of Health and Human Services, fibroids can be as small as an apple seed, while others can grow to the size of a grapefruit and, in rare cases, even larger. Uterine fibroids can cause heavy menstrual bleeding, urinary incontinence, pelvic pain, and in Renee’s case—abdominal extension that resembles pregnancy.1

“I didn’t know what a fibroid even was,” Renee said. “I asked my doctor and she just continued to tell me I had to get a Lupron shot that would put me in a menopausal state to shrink the fibroids and then surgery to take them out. It went from, ‘Renee, you have fibroids,’ to all the way down the rabbit hole! It all seemed so drastic for something that wasn’t cancerous.”

Like many women diagnosed with fibroids, Renee was confused and didn’t understand why surgery was her only option. After hearing the gynecologist’s treatment plan, Renee decided to walk away from that situation in order to investigate all her options. “I started doing my own research,” Renee explained. “There was a lot of information out there but what I found was there was no central hub where women with fibroids could get information on all treatment options available. That was the catalyst for The Fibroids Project.”

Launched in 2010, The Fibroids Project has been an online community empowering women with knowledge. Here they can find the latest research, read about every fibroid treatment option available, and receive support—all with the goal of becoming fibroid-free.

With a dynamic team made up of Renee and co-founder/CIO Nnamdi G. Osuagwu; Chief Medical Experts, Ayman Al-Hendy, MD, PhD, FRCSC, FACOG and Ngozi Osuagwu, MD; Editor-In-Chief, LaShieka Hunter; and Chief Health Coach, Hilary Beard—The Fibroids Project offers a 360-degree view of fibroid treatment, not only for women affected by this condition but for physicians who want to become better informed.

“Our flagship program is a monthly teleconference featuring various experts discussing all aspects of fibroid health,” Renee emphasized. And so far, public response has been tremendous. “It’s phenomenal. People are praising it and saying how much this information is needed. Many of our speakers have had fibroids themselves and this really resonates with our audience.”

The Fibroids Project’s vision is to be a leading uterine fibroids resource by leveraging technology and connecting women to experts in all aspects of fibroid health. But Renee’s vision goes a little deeper. “We still don’t have a cure or a reason for why women get fibroids,” Renee stressed. “Research shows that 80-90 percent of black women and 70 percent of white women will get fibroids by the time they’re 50, which is unreal to me. Clearly, this is an epidemic and something is drastically wrong.”

Being diagnosed with fibroids can be overwhelming and, because of this, it’s imperative women are provided with every piece of information to make an informed decision. “I remember feeling at odds when I was diagnosed with fibroids,” Renee said. “My advice to women is to review all their options prior to making a decision about their healthcare and to not feel intimidated by their doctor. Ask a lot of questions and always get a second opinion.”

Because of trailblazers like Renee and her drive to bring trusted information to women with fibroids everywhere, the secret physical and mental toll of this condition is finally being brought to light.
www.thefibroidsproject.com

REFERENCES
1. US Department of Health and Human Services, Office on Women’s Health. (2015). Uterine Fibroids Fact Sheet. Retrieved August 4, 2015, from https://www.womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.html