INTRODUCTION: The mediating effect of liver disease on cardiac diseases has not been comprehensively outlined in the medical literature. Liver disease can increase your risk of heart disease which remains the leading cause of death in the United States. In this study, we looked at the overview of the mediating effect of liver disease on patients diagnosed with cardiovascular disease (CVD) and how this affects death due to cardiovascular disease. METHODS: We selected patients with a death record from the second-generation Framingham Heart Study database and performed descriptive and analytical tests. Unadjusted tests to understand the variables associated with cardiovascular death were based on t-test and chi-square test when appropriate. A mediation analysis was conducted with patients diagnosed with cardiovascular disease as the independent variable and patients diagnosed with liver disease as the mediator while controlling for possible confounders. RESULTS: Liver disease was not a significant mediator for death due to CVD among patients diagnosed with CVD (P = 0.5882) and only 0.13% of CVD death is attributed to the mediation of liver disease. However, the effect of those diagnosed with CVD on CVD death and the total effect of those diagnosed with CVD and liver disease on CVD death were both statistically significant (P < 0.0001 and P = 0.0017, respectively). CONCLUSION: Liver disease does not significantly mediate CVD death among patients diagnosed with CVD. However, our study is limited to death due to CVD. Furthermore, the death record only contains information on a single cause of death. Patients could have died from multiple complications, but the death records did not collect this data.

INTRODUCTION: Takotsubo cardiomyopathy or stress cardiomyopathy (TCM) is a transient reversible form of cardiomyopathy. It is characterized by reduced ejection fraction and signs of myocardial ischemia and often precipitated by acute emotional or physical stressors. We present a rare case of TCM in a postmenopausal woman triggered by acute alcoholic pancreatitis. CASE DESCRIPTION/METHODS: A 57-year-old female with a history of alcohol abuse and diabetes mellitus presented to the emergency department with a two-day history of severe diffuse abdominal pain with radiation to the back. Associated symptoms included nausea and vomiting. Vital signs were within normal limits. Physical examination was significant for a mildly tender abdomen. Laboratory findings revealed leukocytosis of 14.6 and lipase of 882. All other chemistry and complete blood count labs were within normal limits. CT abdomen without contrast revealed peripancreatic fat stranding suggestive of acute pancreatitis. The patient was admitted for IV fluid resuscitation and pain management. On day 2 of admission, the patient became dyspneic and desaturated to 82% on room air. Stat chest x-ray showed flash pulmonary edema. Bedside ultrasound revealed a dilated IVC. Troponin (0.97) and BNP (1627) levels were elevated, concerning for acute heart failure exacerbation. EKG revealed no acute ischemic changes. The patient was aggressively diuresised with significant improvement in respiratory status. Transthoracic echocardiography (TTE) revealed a left ventricular ejection fraction (LVEF) of 40% with basal segment hyperkinesis but apical akinesis consistent with stress-induced cardiomyopathy. Follow up coronary angiography revealed normal coronary vessels. The patient was started on guideline-based heart failure therapy and was discharged to home in stable condition. A repeat TTE obtained 4 months later revealed unchanged LVEF and persistent apical akinesis in the setting of persistent alcohol use. Guideline directed therapy was continued and the patient was counseled on alcohol cessation. DISCUSSION: Acute pancreatitis induced TCM is rare. Our case further confirms the heterogenicity of TCM, including non-classical stressors such as alcohol abuse which may delay myocardial recovery.

INTRODUCTION: Gallbladder (GB) stasis is highly prevalent in the general population, especially amongst females. It is also one of the most common gastrointestinal causes of hospital admission. A limited number of studies have shown no association between vitamin D levels and gallstone disease in the general population, despite an established association between vitamin D deficiency among pregnant females and GB stasis among pregnant females. METHODS: We used the Framingham Heart Study database and performed descriptive and multivariate tests to identify possible confounders not limited to vitamin D levels that are associated with GB stasis. Unadjusted tests were based on t-test and chi-square test when appropriate. Logistic regression analyses were performed with possible confounders of GB stasis. In order to understand the high prevalence of GB among females, both univariate and multivariate tests were performed on the sub-sample of females. RESULTS: Gender was predictive of GB stasis, with females being more likely to have GB stasis (P < 0.0001). Age (P < 0.0001) and body mass index (P < 0.0001) were associated with GB stasis in the entire study population. In the sub-sample of females only, high density lipoprotein cholesterol (HDL) showed a significant association to GB stasis with a negative estimate of the coefficient of interest, signifying that higher levels of HDL were protective against GB stasis among females. However, there was no significant difference in GB stasis based on Vitamin D levels (P = 0.3213). CONCLUSION: Vitamin D levels are not significantly associated with GB stasis in the general population. However, a closed study of age of onset of GB stasis, sex differences in GB stasis, effect of BMI, and the effect of HDL to GB stasis require much more attention to the understanding of the disease.

No abstract