Body

A recent review in Clinical Obesity assessed patients' reactions to consultations with physicians in which excess weight could have been or was discussed. In the review of 21 qualitative studies interviewing people who were overweight or obese who had consulted a primary care clinician, participants had only occasional interactions with clinicians about their weight, and the most important and most commonly reported were negative experiences.

Where interactions addressed weight, the language used, the tone of the consultation, and the nature of the advice were critical. Participants reported being given advice that was unhelpful or that implied they were stupid. On occasions, participants reported discussions about weight loss options available and this was universally appreciated. No one appreciated being scolded about being overweight or made to feel personally responsible for symptoms potentially related to weight. Some participants felt their health problems were dismissed as obviously weight-related and left unexplored and untreated as a result.

"People with excess body weight are often judged negatively by others and are highly sensitized to the doctor or nurse doing so. Doctors and nurses should remember that people often know what they should do and are looking for support in how to achieve this," said senior author Paul Aveyard, PhD, MRCP, FRCGP, FFPH, of the University of Oxford, in the UK.

Although colorectal cancer is associated with obesity, it is unclear if weight loss surgery impacts the incidence of these tumors. Results from a new study published in the International Journal of Cancer suggest that the risk of colon cancer may be increased in individuals who have undergone such surgery.

In the population-based study of 502,772 individuals with obesity from five Nordic countries, patients who underwent weight loss surgery had a higher risk of colon cancer than the general population.

This risk seemed to increase over time, and it exceeded the elevated risk of obese individuals without such surgery. The association between weight loss surgery and rectal cancer was weaker, but it tended to increase with longer follow-up.

Successful weight loss approaches in older adults with obesity can unfortunately lead to bone loss and an increased risk of fractures. A recent Journal of Bone and Mineral Research study examined which forms of exercise might help reduce such bone loss.

In the randomized controlled trial of 160 obese men and women aged 65 years or older who were living in New Mexico, investigators found that resistance exercise, alone or combined with aerobic exercise, was effective in reducing weight loss-induced decreases in hip bone density. Intriguingly, aerobic exercise alone was not effective. Therefore, resistance exercise can be recommended to protect against bone loss during weight loss regimens in older adults with obesity.

"It is never too late to practice a healthy lifestyle through diet and regular exercise, especially that which includes resistance exercise to improve physical function and preserve bone health during aging," said senior author Dennis T. Villareal, MD, of?Baylor College of Medicine.

An analysis published in the Journal of the European Academy of Dermatology and Venereology revealed considerable sex differences when considering links between psoriasis and metabolic disorders.

In the study of 3,723 adults, 25.8% of the women had metabolic syndrome, and the prevalence was higher in women with psoriasis than without (36.8% versus 25.4%). Similarly, more women with psoriasis had diabetes (12%) than those without psoriasis (5%).

The prevalence of metabolic syndrome in men was 37.9%. Contrary to what was seen in women, men with psoriasis less often had metabolic syndrome than men without psoriasis (27% versus 38%). The prevalence of diabetes was slightly higher in men with psoriasis compared with men without psoriasis (12% versus 8%).

In a Maternal & Child Nutrition analysis of published studies on the dietary habits of women who were trying to conceive or were pregnant, most studies indicated that women do not meet nutritional recommendations for vegetable, cereal grain, or folate intake. Pregnant women did not meet iron or calcium intake requirements in 91% and 55% of studies, respectively, and also exceeded fat intake recommendations in 55% of studies. Higher level education was associated with improved adherence to dietary guidelines in pregnant women, and older age and non-smoking status were associated with greater guideline adherence in both preconceptual and pregnant women.

The findings suggest that preconceptual and pregnant women may not be meeting the minimum requirements of a healthy diet. This could have potential negative consequences for pregnancies and the health of offspring.

"The relationship between a healthy diet and birth outcomes is well-established, yet our research suggests women may not be following the guidelines developed to help them eat well, largely because they are unaware of the guidelines in the first place," said corresponding author Cherie Caut, of Endeavour College of Natural Health, in Australia. "The community needs better information about healthy eating in order to address this issue. Promoting links between diet and healthy pregnancy and birth, and increasing support for health professionals, may help better inform women and their partners about the importance of dietary choices on pregnancy success."

Exposure to traffic pollution was associated with a higher risk of obesity in Mexican American women, but not in men. The findings are published in Obesity.

In the study of 7,826 Mexican American adults, more than half (53.6%) of participants had a body mass index (BMI) indicative of obesity, with a higher prevalence in women than in men.

Exposure to higher traffic-related air pollution was associated with lower BMI in men but higher BMI in women.

What The Study Did: Researchers in this observational study looked at how race was associated with difference in symptoms, access to care, genetic testing and clinical outcomes among 2,467 patients (8.3% black and 91.7% white) with hypertrophic cardiomyopathy, a condition where the heart muscle becomes abnormally thick, which can make it harder to pump blood.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

Authors: Neal K. Lakdawala, M.D., of Brigham and Women's Hospital in Boston, is the corresponding author.

(doi:10.1001/jamacardio.2019.4638)

Editor's Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Contrary to accepted knowledge, blood can bring more oxygen to mice brains when they exercise because the increased respiration packs more oxygen into the hemoglobin, according to an international team of researchers who believe that this holds true for all mammals.

"Standard thought was that mammalian blood is always completely saturated with oxygen," said Patrick J. Drew, Huck Distinguished Associate Professor of Neural Engineering and Neurosurgery and associate director of the Penn State Neuroscience Institute.

That would mean that the only way to get more oxygen to the brain would be to get more blood to the brain by increasing blood flow. The researchers were interested in seeing how brain oxygen levels were affected by natural behaviors, specifically exercise.

"We know that people change breathing patterns when doing cognitive tasks," said Drew. "In fact, respiration phase locks to the task at hand. In the brain, increases in neural activity usually are accompanied by increases in blood flow."

However, exactly what is happening in the body was unknown, so the researchers used mice who could chose to walk or run on a treadmill and monitored their respiration, neural activity, blood flow and brain oxygenation.

"We predicted that brain oxygenation would depend on neural activity and blood flow," said Qing Guang Zhang, postdoctoral fellow in engineering science and mechanics. "We expected the oxygenation would drop in the brain's frontal cortex if blood flow decreased.

"That was what we thought would happen, but then we realized it was the respiration that was keeping the oxygenation up."

The only way that could happen would be if exercise was causing the blood to carry more oxygen, he explained, which would mean that the blood was not normally completely saturated with oxygen.

The researchers looked at oxygenation in the somatosensory cortex and the frontal cortex -- which is an area involved in cognition -- and the olfactory bulb -- an area involved in the sense of smell -- because they are the most accessible areas of the brain.

They used a variety of methods to monitor respiration, blood flow and oxygenation. They also tested oxygenation levels while suppressing neural activity and blood vessel dilation.

The researchers report in today's (Dec. 4) issue of Nature Communications that "The oxygenation persisted when neural activity and functional hyperemia (blood flow increases) were blocked, occurred both in the tissue and in arteries feeding the brain, and were tightly correlated with respiration rate and the phase of respiration cycle."

They conclude that "respiration provides a dynamic pathway for modulating cerebral oxygenation."

DUARTE, Calif. -- Kidney cancer patients who had already tried two or three different treatments had improved chances of preventing cancer progression with an experimental drug called tivozanib compared to an alternative approved by the U.S. Food and Drug Administration, according to a City of Hope-led study.

"This agent has shown in clinical trials to be effective in delaying cancer growth beyond established standards for patients who have returning kidney cancer," said Sumanta Pal, M.D., a medical oncologist at City of Hope and co-lead author of the new study. "Although there are many options for patients with kidney cancer today, most are intended for first- and second-line therapy. We need a treatment that works for kidney cancer patients who have failed several lines of therapy."

Published in The Lancet Oncology on Dec. 3, the study is the first to show the benefit of tivozanib for patients with renal cell carcinoma (the most common form of kidney cancer) who had received two or more previous therapies, Pal said. Although not yet approved in the United States, tivozanib is a blood vessel growth inhibitor that has been approved by the European Medicines Agency for first-line treatment of adults with renal cell carcinoma.

The multicenter phase 3 study randomly assigned 350 adult patients with metastatic renal cell carcinoma to receive either tivozanib or the FDA-approved sorafenib for a median of 19 months. This targeted therapy, a "VEGFR inhibitor," hinders the growth of new blood vessels, the fuel source for tumors.

The patients had a median age of 63 and were based at 120 centers in 12 different countries. They had received at least one VEGFR inhibitor treatment in their previous two or three treatments. Yet, they had never received tivozanib or sorafenib.

At one year, progression-free survival was 28% with tivozanib compared to 11% with sorafenib. At the two-year mark, progression-free survival was 18% with tivozanib and 5% with sorafenib. The therapeutic benefit of tivozanib appeared to extend to patients who had received checkpoint inhibitors and those who were treated with two previous blood vessel growth inhibitors.

"City of Hope has a robust clinical trial program that often leads to practice-changing findings, and this is just one example of that," Pal said. "We are well known for working on investigational new drugs, and this is a late-stage study that is providing new options for patients with kidney cancer."

At the study's end, 70 patients in the tivozanib group (40%) and 82 patients in the sorafenib group (47%) had received subsequent anti-cancer therapy, meaning their cancer had progressed.

Tivozanib (FOTIVDA) is owned by AVEO Oncology, which plans to submit a new drug application in the first quarter of 2020 to the FDA so that this targeted therapy can used by patients with relapsed/refractory renal cell carcinoma, according to AVEO Oncology website.

ANN ARBOR, Mich. - Women in rural communities experience higher rates of life-threatening complications during or after childbirth than mothers in urban cities, a new study finds.

Maternal deaths and deliveries requiring emergency, life-saving treatment are increasing among both rural and urban residents, up from 109 to 152 per 10,000 childbirth hospitalizations, the new research finds.

But rural residents have a 9% greater chance of dangerous childbirth situations than urban peers - with about 4,400 more cases over the study period- according to the findings that were published in Health Affairs' December issue.

Researchers analyzed 6.8 million births from national hospital discharge data between 2007 to 2015.

"Our study suggests that geographic disparities may put rural women at an increased risk of requiring life-saving interventions during or immediately after delivering a baby," says senior author Lindsay Admon, M.D., M.Sc., an obstetrician-gynecologist at Michigan Medicine's Von Voigtlander Women's Hospital.

"Policies and programs aiming to improve maternal health and reduce adverse events associated with delivery must address the unique health needs and challenges face by rural women."

Tens of thousands of American women each year need emergency treatment to save their lives while they deliver babies or immediately after, including blood transfusions, interventions for heart failure or stroke, or an emergency hysterectomy associated with birth.

The incidence of such cases in the United States nearly tripled between 1998 and 2014 while maternal mortality also increased dramatically, with nearly 700 maternal deaths a year.

"Where you live shouldn't dictate the outcome of your pregnancy," says lead author Katy Kozhimannil, Ph.D., M.P.A., director of the University of Minnesota's Rural Health Research Center and associate professor in the Division of Health Policy and Management at the University of Minnesota's School of Public Health.

"In rural areas, where there is declining access to obstetric services, it is alarming that more and more people are facing severe maternal morbidity and mortality when giving birth."

Risk factors for rural communities

Authors note stark differences between rural and urban communities that may influence risks. Compared to urban residents, rural residents face more severe health care workforce shortages and travel longer distances to receive maternity care. By 2014, for example, more than half of rural counties had no hospital that provided childbirth services and 179 rural counties actually lost obstetric services between 2004-2014.

The effects of these lost services hit remote rural communities hard, where residents subsequently experienced increased rates of preterm birth (the leading cause of infant mortality), out of hospital birth, and births occurring in hospitals without obstetric units.

The new study also found that people with Medicaid coverage or patients with no insurance at delivery had at least 30% increased odds of severe maternal morbidity and mortality, compared to those with private health insurance. Rural women were more likely to use Medicaid as a primary insurance - with nearly half covered by Medicaid compared to 40% of urban women.

Authors say that policy reforms associated with Medicaid, such as increasing reimbursement to rural health centers and expanding coverage beyond the traditional prenatal to 60-day postpartum period, are important considerations to help address these life-altering experiences for pregnant women, their families, and rural communities.

Admon's previous research has found that pregnant women today are more likely to have chronic conditions that cause life-threatening complications than at any other time in the past decade -- particularly women living in rural and low-income communities.

Ensuring women have access to ongoing care before and after pregnancy, is key to addressing underlying chronic conditions, such as hypertension, obesity and diabetes, Admon says.

"We are seeing an increasing prevalence of pre-existing chronic conditions that increase the risk of adverse gestational outcomes for moms and their newborns. It's difficult to address these health issues if maternal health benefits, such as those associated with Medicaid coverage, are limited to the nine months of pregnancy and just two months of care after pregnancy," says Admon, who is also a researcher at the University of Michigan's Institute for Healthcare Policy and Innovation.

"Rural communities face greater challenges to achieving improvements in health," she adds. "It's important to use this information to help us target programs that will benefit the populations at greatest risk of adverse maternal health outcomes. We should direct and adapt resources to meet the needs of communities where public health interventions may have the greatest impact."

Glioblastoma (GBM) is the most aggressive brain tumor in adults. Now, it can be treated with neurosurgery, radiotherapy and chemotherapy. Still, the median life expectancy of patients affected with this pathology is no longer than 15 months.

Within this context, researchers at the Universitat Politècnica de València (UPV) have been working for 15 years in new biomedical tools that can help to the follow-up of this tumor. The last of them is ONCOHabitats, a platform that allows medical doctors to know the patient's real situation with greater precision according to the vascularity of different areas of the tumor.

"These results consolidate the effort of almost 15 years working in this field. The potential application of this tool has been now validated by seven European hospitals with the first multicenter clinical study promoted by the Universitat Politècnica de València," says Juan Miguel García-Gómez, coordinator of the Biomedical Data Science Lab-ITACA of UPV.

The seven centers that have taken part in the study are the Hospital Universitario de La Ribera, the Hospital de Manises, the Hospital Clínic in Barcelona, the Hospital Universitario Vall d'Hebrón, the Azienda Ospedaliero-Universitaria in Parma (Italy), the Centre Hospitalier Universitaire in Liège (Belgium) and the Oslo University Hospital (Norway). The results have been published in the Journal of Magnetic Resonance Imaging.

Key finding for medical prognosis

The methodology developed by the team of UPV researchers helps to discover new areas in the tumor and makes the monitoring of the patient's evolution easier, thanks to new biomarkers. The key lies in the analysis of five types of Magnetic Resonance Images - four morphological MRIs and one perfusion MRI.

According to the researchers at UPV's Biomedical Data Science Lab-ITACA, from these Magnetic Resonance Images and our methodology, it is possible to establish separated areas inside the tumor and the edema. From them, ONCOHabitats allows medical doctors to obtain vascular biomarkers--brain blood volume--in the areas of the active tumor and Infiltrated Peripheral Edema that are directly linked to the patients' survival, before they undergo surgery.

Until now, most studies have focused on studying the active tumor. However, we have found a new area of great interest, the Infiltrated Peripheral Edema. We have seen that the biomarkers obtained in this area provide very relevant information on the aggressiveness of the tumor and therefore, on the prognosis and follow-up of the patient.

Within the study, researchers worked with 184 patients' MRIs from the seven centers that took part. The study has proved the robustness of calculating biomarkers using the methodology developed by UPV compared to the variability of applying Magnetic Resonance Images acquisition protocols.

"We have proved in seven hospitals that our methodology is reliable and robust, independently of the variations that can appear when acquiring and processing MRIs and, ultimately, obtaining the biomarkers. These results endorse its viability for the implantation in the clinical practice; the next step is to biologically characterize what it is discovered in the image, and we are already working on it," explains María del Mar Álvarez-Torres, researcher at the Biomedical Data Science Lab-ITACA of the Universitat Politècnica de València.

The cover for issue 64 of Oncotarget features Figure 5, "In vivo and ex-vivo growth kinetics of B6CaP," by Simons, et al.

The Research Team reports the establishment of B6Ca P, an allograft tumor line from a Hi-Myc transgenic mouse that had been backcrossed onto C57BL/6J background.

This is the first example of a prostate-derived tumor line that shows frequent metastasis to bone and grows in an immunocompetent host, making this model useful for studying mechanisms of bone metastasis and tumor immune response.

Dr. Edward M. Schaeffer from the Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA said, "Prostate cancer (PCa) is the most common non-cutaneous cancer in the United States, and is the third leading cause of cancer-related deaths in men."

Animal models of cancer allow the study of molecular mechanisms of disease progression and test new treatments across the disease sites; but an uncommon occurrence of spontaneous prostate cancer in mice and a lack of animal model systems that closely recapitulate the human PCa hampers the mechanistic understanding of metastatic progression and development of effective treatments for advanced PCa. While xenografts of human cell lines in immunodeficient mice remain the most commonly used models, PCa cell lines rarely metastasize from subcutaneous grafts, with an exception of a few cell lines that metastasize when injected orthotopically.

To overcome these problems, numerous genetically engineered mouse models of PCa have been developed over the years including the TRAMP model that displays PCa metastases to distant organs such as lung, but rarely to bones, a feature consistent in other transgenic mouse models as well.

Intracardiac injection of B6Ca P results in frequent skeletal metastases, making it an excellent pre-clinical model to study the mechanisms of metastasis in PCa.

The Schaeffer Research Team concluded that, taken together, B6Ca P line overcomes two critical limitations to study the skeletal metastasis of prostate cancer.

Why is it that some people love to exercise, and others hate it? Most people would assume it's all due to genetics, but a new Baylor College of Medicine led study in mice shows for the first time that a different molecular level of regulation - epigenetics - plays a key role in determining one's innate drive to exercise. Epigenetics refers to molecular mechanisms that determine which genes are turned on or off in different cell types. Since epigenetic mechanisms are inherently more malleable than genetics, the findings suggest a potential way to help 'program' people to enjoy being more physically active.

Today, in the journal Nature Communications, Baylor researchers and colleagues report the surprising creation of an 'epigenetic couch potato' mouse. They found that in neurons within a part of the brain called the hypothalamus, changes in DNA methylation - the addition of methyl chemical tags in the DNA - have a major impact on levels of voluntary exercise behavior.

"We study developmental programming, which refers to how the environment during development can have a long term impact on risk of disease," said corresponding author, Dr. Robert A. Waterland, professor of pediatrics - nutrition at the USDA/ARS Children's Nutrition Research Center at Baylor and Texas Children's Hospital.

Over the last several years, the researchers studied various mouse models to understand developmental programming of energy balance, that is, the balance of calories consumed vs. those burned off. A prolonged positive energy balance leads to obesity. Remarkably, whether the early environmental influence was fetal growth restriction, infant overnutrition, or maternal exercise during pregnancy, the long-term effect on energy balance was always due to persistent changes in physical activity, not food intake.

"Our earlier findings suggested that establishment of one's physical activity 'set point' can be affected by early environment, and that this may involve epigenetics," said Waterland, who also is a professor of molecular and human genetics and a member of the Dan L Duncan Comprehensive Cancer Center at Baylor.

How the brain regulates the body's energy balance

In the current study, Waterland and his colleagues designed an experiment to directly test whether DNA methylation in the brain affects energy balance. They focused on the hypothalamus, a brain region that plays a central role in energy balance, and in particular, studied a specialized subset of hypothalamic neurons called AgRP neurons, famous for their role in regulating food intake.

The researchers disrupted DNA methylation in AgRP neurons by disabling the Dnmt3a gene. Dnmt3a is responsible for adding methyl groups to DNA, particularly in the brain during early postnatal life. The results showed that, indeed, DNA methylation was dramatically reduced in AgRP neurons of these mice. The investigators then tested whether these animals gained or lost weight when compared to normal mice.

"We expected that interfering with DNA methylation in AgRP neurons would result in major changes in the animals' weight," said Dr. Harry MacKay, a postdoctoral fellow in the Waterland lab and first author of the study. "Somewhat disappointingly, however, the Dnmt3a-deficient mice were only slightly fatter than those that were not deficient."

But when the researchers explored the cause of this change in energy balance, things got more interesting. The team expected to find differences in food intake between normal and Dnmt3a-deficient mice. But there were none. Instead, they found a major difference in spontaneous physical exercise.

The researchers placed running wheels in the animals' cages for eight weeks and measured how much they ran each night. Normal male mice ran about 6 Km (3,7 miles) every night, but the Dnmt3a-deficient mice ran only half as much and, accordingly, lost less fat. Importantly, detailed treadmill studies showed that, although they ran only half as much as normal mice, the Dnmt3a-deficient mice were just as capable of running. They had the ability, but appeared to lack the desire.

"Our findings suggest that epigenetic mechanisms, such as DNA methylation, that are established in the brain during fetal or early postnatal life, play a major role in determining individual propensity for exercise," Waterland said. "Nowadays, as decreases in physical activity contribute to the worldwide obesity epidemic, it is increasingly important to understand how all of this works."

ATLANTA - The American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) released the 2019 ACR/EULAR Classification Criteria for IgG4-Related Disease. It is the first criteria developed specifically for this recently recognized disease.

A draft of the criteria was presented during the 2018 ACR/ARP Annual Meeting in Chicago. Since that time, the criteria team performed a second validation study, which confirmed the high sensitivity and specificity that was found in the first validation study.

IgG4-Related Disease (IgG4-RD) is an immune-mediated disease that may affect different organ systems and often mimics other diseases like Sjögren's syndrome, pancreatic cancer, granulomatosis with polyangiitis (GPA), giant cell arteritis (GCA) and systemic lupus erythematosus (SLE or lupus). Only recognized in the last 10 to 15 years, IgG4-RD can cause fibro-inflammatory lesions in nearly any organ or multiple organs. Estimates suggest that IgG4-RD affects 180,000 people in the United States and many more worldwide.

"IgG4-RD is now recognized to be a worldwide condition that is seen not only by rheumatologists but also generalists and sub-specialists of nearly every kind," said John H. Stone, MD, MPH, professor of medicine at Harvard Medical School and director of the international panel of experts who developed the new criteria. "Clinical trials are now being developed in IgG4-RD and investigators need criteria on which to base patients' inclusion or exclusion for such trials and other types of investigation."

Classification criteria allow researchers to accurately identify patients for inclusion in clinical, epidemiologic and basic investigations. The panel of experts who developed the new classification criteria included investigators from rheumatology and other specialties from five continents, reflecting the worldwide impact of this disease.

In the criteria, classifying patients with IgG4-RD is a three-step process that carefully assesses data from four domains, which must make sense in the context of IgG4-RD. The process includes synthesizing information from the patient's clinical presentation, blood test results or serology, radiological findings and the pathology data. Few other diseases require such careful synthesis of various information to get an accurate diagnosis, and at this time, there is no single diagnostic test for the disease.

The 2019 ACR/EULAR Classification Criteria for IgG4-Related Disease were validated in a large cohort of patients and demonstrated excellent test performances. Dr. Stone feels they should be a highly useful contribution to future investigations in this disease, and will ultimately help improve the lives of patients with IgG4-RD.

"IgG4-RD is a disease that tends to afflict middle-aged to elderly individuals and often affects and damages the pancreas severely, making glucocorticoids a suboptimal therapy for this condition," Dr. Stone says. "Clinical trials will help develop targeted therapies that spare toxicities from conventional treatments. Investigators need to have criteria like this to determine whether a patient should be classified as having IgG4-RD."

Dr. Stone is a professor of medicine for Harvard Medical School and the Edward A. Fox Chair in Medicine at Massachusetts General Hospital.

Future cardiac outcomes can be predicted by signs of cardiac stress that appear in the blood in response to exercise, Emory cardiologists report.

The results were published Wed Dec 4 in JAMA Cardiology.

Identifying patients with otherwise stable coronary artery disease (CAD) who are high-risk and would benefit from more intense or invasive interventions is currently a major theme in cardiology research. Often CAD patients undergo a treadmill exercise test to look for signs of blockages in their coronary arteries, and Emory researchers have been examining measurements that could provide additional information on which patients may be at highest risk of cardiac events such as heart attack.

In this study, Emory researchers looked at how circulating progenitor cells can disappear from the blood, presumably because they're needed in the heart. Circulating progenitor cells (or CPCs), which can be thought of as blood vessel "repair crews", are derived from the bone marrow and circulate in the blood at low levels.

In healthy people, physical exercise causes the cells to leave the bone marrow and enter the blood, because their job is repairing blood vessels. In people with coronary artery disease whose arteries are narrowed enough so that they develop ischemia (restriction of blood flow), more of the cells are diverted to the heart to repair the damage.

"A fall in CPC count after exercise appears to be an independent determinant of high risk in patients with stable coronary artery disease, even after adjusting for known clinical risk factors," says first author Kasra Moazzami, MD, cardiovascular research fellow at Emory Clinical Cardiovascular Research Institute. "The information gained from the changes in CPC counts during exercise may be more useful to cardiologists in risk stratifying these patients than the treadmill exercise test itself."

Moazzami is also affiliated with the Department of Epidemiology at Rollins School of Public Health. Arshed Quyyumi, MD, director of Emory Clinical Cardiovascular Research Institute, is senior author of the paper.

The Emory team took advantage of data from the Mental Stress Ischemia Prognosis Study, looking at 454 patients with stable coronary artery disease. They were divided into two groups, based on whether CPC counts increased or decreased during a treadmill exercise test. People whose CPC counts decreased were more than twice as likely to experience heart attack or die from heart disease over the next three years, even taking standard risk factors into account.

In particular, monitoring the CPC response to exercise provided more information than nuclear imaging for cardiac ischemia (restriction of blood flow). This was significant because imaging procedures can contribute to radiation exposure.

In previous research, the Emory team demonstrated that a decrease in CPC counts is a sign of ischemia. The current paper extended the findings to outcomes.