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Drs. Roizen and Oz: Shoulder injury can be indicator of heart disease

Copyright 2014 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.The Associated Press
Monday, January 30, 2017 07:50 am
Q: I recently injured my rotator cuff while swimming. I'm 61 and in good health, but when I went to my doctor, he said he wants me to get an EKG as well as an MRI for my shoulder. Since when is my shoulder connected to my heart? Is this a case of overtesting? — Jeannie N., Nashville, Tenn. A: Sorry about your shoulder, Jeannie, but your doctor probably wasn't overtesting. For people over 60, shoulder injuries sometimes can indicate that something else, such as heart disease, is going on. A recent study in the Journal of Occupational and Environmental Medicine revealed a strong correlation between rotator cuff tendinopathy (various forms of tendonitis) and localized joint pain and cardiovascular disease (CVD). Liver and gallbladder disease also can cause referred shoulder pain!

Now, since you're a swimmer, your chances of having CVD are reduced. There's a better chance that your shoulder injury is due to repetitive use. All of the soft tissue surrounding the shoulder loses some of its flexibility with age. An MRI usually will ID the problem.

Here are a few things you should know: First, the shoulder joint is the most versatile and mobile joint in your body. It moves backward, forward, up, down and around in circles because of the rotator cuff, which connects all the muscles to the bones of the shoulder. It's made up of four tendons that form a covering over the head of the upper arm bone (humerus) and top of the shoulder. If you're a seasoned swimmer and this is your first run-in with rotator cuff problems, you're fortunate.

Second, physical therapy is in your future whether your injury requires surgery or not. Whatever the results, follow your prescription for therapy to the letter (get a second opinion for peace of mind — you can take your test results to the second doc), and you'll be back in the pool in the shortest and most appropriate amount of time possible!

Q: My doctor told me that I should lower my non-HDL cholesterol level. I've heard about LDL, the bad cholesterol, but what exactly is non-HDL, and what is a healthy level? — Judith L., West Lafayette, Ind.

A: Don't let the phrase "non-HDL" confuse you. ("H" is for "healthy.") Your goals are still the same: to protect your heart, brain and sex life by lowering your lousy cholesterol levels, no matter what you call them. Your first step is to make lifestyle adjustments, such as losing weight if you need to, getting in 10,000 steps or the equivalent daily and ditching the inflammation-producing Five Food Felons (all trans and most sat fats, added sugars and syrups, and any grain that isn't 100 percent whole). Your second is to take a modern statin (atorvastatin or rosuvastatin) if lifestyle changes don't do the trick.

But what does "non-HDL" mean? Well, very simply, it means all the blood lipids (fats) you have that are NOT attached to HDL, the good-for-you-because-it-transports-cholesterol-out-of-your-body lipoprotein.

The lousy LDL cholesterol you hear so much about isn't the only artery-clogging, heart-damaging lipid. There are VLDL (very low density lipoprotein), IDL (intermediate density lipoprotein), and small dense LDL particles — and let's not forget triglycerides. All those various non-HDL lipids contribute to blocked arteries and heart disease. So knowing the total non-HDL level, according to a study out of Dr. Mike's Cleveland Clinic, is a better predictor of heart woes, and lowering that level is a better predictor of reduced cardiovascular risk.

What's your goal? We think you should aim for a non-HDL level of less than 130 mg/dL (30 above our recommendation for LDL and triglycerides). To figure out your non-HDL level, subtract your HDL level from your TOTAL cholesterol level.

But wait! For folks with cardiovascular disease plus diabetes, or cardiovascular disease and poorly controlled risk factors (like smoking or being overweight), metabolic syndrome or acute coronary syndrome, the target should be 100 mg/dL or lower. 

Dr. Mehmet Oz is host of “The Dr. Oz Show,” and Dr. Mike Roizen is Chief Wellness Officer and Chair of Wellness Institute at Cleveland Clinic. Email your health and wellness questions to youdocsdaily@sharecare.com.

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