A low level of HDL cholesterol is an independent risk factor for cardiovascular disease.

The analysis, which reviewed 25 studies published between 1966 and 2005, assessed the effects of aerobic exercise on HDL cholesterol in a total of more than 1,400 adults ranging in age from 23 to 75. The studies lasted an average of 27.4 weeks. On average, participants exercised 3.7 sessions per week for 40.5 minutes each session, burning an average of 1,019 calories per week.

The combined findings showed that exercise resulted in an average increase in HDL cholesterol of 2.53 milligrams per deciliter. The minimum amount of exercise required to change HDL cholesterol levels was 120 minutes a week or 900 calories burned. Exercise had a greater impact in people with a higher total cholesterol level (220 milligrams per deciliter or greater) and in people with a body mass index (BMI) of less than 28 (obesity begins at a BMI of 30).

"In a previous observational study, every 1-milligram per deciliter increment in HDL cholesterol level was reported to be associated with a 2 percent and 3 percent decreased risk of cardiovascular disease in men and women, respectively," the review authors wrote.

"If this observation were applied to our results, the increase in HDL cholesterol level by exercise determined by this analysis would, by a rough estimate, result in cardiovascular disease risk reduced by approximately 5.1 percent in men and 7.6 percent in women."

The authors noted that their analysis showed that only exercise duration, not frequency of intensity, was associated with a changed in HDL cholesterol levels.

The article was published in the May 28 issue of the journal Archives of Internal Medicine.

SOURCE: JAMA/Archives journals, news release, May 28, 2007
Publish Date: May 30, 2007

These biomarkers, called cytokines, are all hallmarks of heightened inflammatory responses. Cytokines specific to Alzheimer's disease were found in greater numbers on white blood cells called mononuclear cells.

Higher concentrations of inflammatory markers in the blood have been linked to Alzheimer's disease before. But other conditions of old age, such as heart disease and arthritis, can also trigger inflammation, the researchers pointed out.

However, the newly discovered markers point specifically at Alzheimer's disease-linked inflammation in the brain, the scientists said.

That's important, because right now "there's no single blood test or neuroimaging study -- CT scan or MRI -- that can reliably predict whether somebody has Alzheimer's disease, much less whether someone is at risk of developing the illness," explained lead researcher Dr. Zaldy Tan, director of the Memory Disorders Clinic at Beth Israel Deaconess Medical Center, in Boston.

"So, if this finding is validated in other studies and larger samples, it might become a test for future risk of Alzheimer's disease," he said.

There are currently no effective treatments for Alzheimer's disease, which now affects more than 5 million Americans, according to the Alzheimer's Association. Scientists project that unless new ways are found to prevent or treat the disease, that total could climb to 16 million by mid-century.

The exact role of inflammatory processes in Alzheimer's remains a mystery, although numerous studies support the notion that they are at least associated with the mind-robbing illness.

"The data has been conflicting," Tan said. "Most of the studies out there are population-based, looking at the use of anti-inflammatory drugs, for example, on the incidence of Alzheimer's disease." Those studies have found no good evidence that taking steroids or nonsteroidal anti-inflammatories (for example, aspirin or ibuprofen) cuts Alzheimer's risk.

Tougher still has been the search for a blood marker that might precisely indicate the presence of, or risk for, Alzheimer's disease in a particular patient.

A number of studies with elderly patients have correlated a high number of cytokines in red blood cells with Alzheimer's, but "since this population is significantly older, there are other reasons someone might have inflammation -- arthritis, for example," Tan said.

The new study, published in the May 29 issue of Neurology, focused on a particular type of white blood cell, the mononuclear cell. Tan's team focused on these cells because they have the ability -- unlike many other cells -- to cross the blood-brain barrier.

Taking advantage of the ongoing Framingham Heart Study, Tan and his colleagues periodically tested the blood of 691 healthy elderly participants averaging 79 years of age. Then they tracked the volunteers' mental health for the next seven years.

Over that period of time, 44 of the participants developed Alzheimer's disease.

The researchers found that individuals with the highest levels of mononuclear cell-derived inflammatory cytokines were twice as likely to develop the illness as those with the lowest levels of the inflammatory markers.

"So, our hypothesis now is that it is possible to indirectly measure [Alzheimer's-linked] brain inflammation by looking at the amount of inflammatory markers released by these blood cells, cells that may eventually make it to the brain," Tan said.

One expert agreed the finding could someday lead to a real advance in the care and understanding of Alzheimer's disease.

"What this study does is take us to another level in terms of diagnostics," said Paul Sanberg, director of the Center of Excellence for Aging and Brain Repair at the University of South Florida College of Medicine, in Tampa. "They are finding a more consistent result when they look at the inflammatory markers in mononuclear cells."

He said the jury is still out on whether treating inflammation might prevent or treat Alzheimer's, since no one is sure whether inflammation helps cause the disease or is simply a product of the illness.

But if it turns out that dampening inflammation can help, a blood test measuring these cytokines might be of great use to doctors, Sanberg said. "If you can find a consistent marker, then maybe some patients might be treated by anti-inflammatories better than others, depending on the [blood] level of these markers," he said.

Tan agreed that it's too early to talk about treatments, but he believes the new finding brings effective diagnostics and therapy that much closer.

"This is another piece of the puzzle in the mechanism of Alzheimer's disease," he said.

SOURCES: Zaldy Tan, M.D., director, Memory Disorders Clinic, Beth Israel Deaconess Medical Center, Boston; Paul Sanberg, Ph.D., distinguished professor, and director, Center of Excellence for Aging and Brain Repair, University of South Florida College of Medicine, Tampa; May 29, 2007, Neurology
Publish Date: May 30, 2007.

In turn, aortic inflammation can promote atherosclerosis ("hardening of the arteries") and the formation of aneurysms and increase risks for heart attack and death, according to a study in the June issue of the journal Arthritis & Rheumatism.

In the study, American and Norwegian researchers analyzed samples of aortic tissue from 66 coronary artery bypass patients with inflammatory rheumatic disease and a control group of 51 bypass patients without the condition.

Rheumatoid arthritis, psoriatic arthritis, lupus, ankylosing spondylitis, and polymyalgia were among the types of inflammatory rheumatic diseases afflicting the patients in the study.

The researchers found that patients with inflammatory rheumatic disease were more likely than patients in the control group to have inflammation-related cells in their aortic tissue. Patients who smoked were also more likely to have these kinds of cells.

"The opportunities for detecting aortic inflammation are limited," study spokesperson Dr. Ivana Hollan said in a prepared statement. "Our method of tissue examination allows the condition to be diagnosed in patients undergoing CABG surgery without increasing the preoperative risk."

The findings indicate the need for further research into an inflammatory process that may increase the risk of dying from a heart attack or aneurysm, the researchers said.

SOURCE: Arthritis & Rheumatism, news release, May 25, 2007
Publish Date: May 30, 2007

Along with exercise, pulmonary rehabilitation can include education, instruction in various respiratory techniques, and psychosocial support. Research shows that this kind of program is appropriate for any patient with stable COPD who is disabled by respiratory symptoms.

The guidelines, which are published in the May issue of the journal Chest, state that pulmonary rehabilitation can improve a COPD patient's exercise tolerance, breathing problems (dyspnea), and quality of life, while reducing the use of health care services and length of hospital stays.

"COPD partially blocks airways, making it difficult to breathe and participate in simple, everyday activities," Dr. Andrew Ries, chair of the guideline writing committee, said in a prepared statement.

"The primary goal of pulmonary rehabilitation is to restore the patient to the highest possible level of independent function. We want patients to become more physically active and to learn more about their disease, treatment options, and how to cope," Ries said.

He and his colleagues noted that pulmonary rehabilitation can also benefit people with other respiratory diseases, including asthma, lung cancer, and pulmonary fibrosis.

SOURCE: American College of Chest Physicians, news release, May 7, 2007
Publish Date: May 30, 2007

This technology potentially eliminates the need for inserting a catheter to perform invasive angiography, Dutch cardiologists report.

"Eventually, the goal is to avoid invasive angiography," said Dr. Jeroen J. Bax, professor of cardiology at Leiden University Medical Center, a member of the team reporting the study findings. "We are not there yet, but it is moving in the right direction."

But the technique is not likely to be available widely in the near future, because it requires intensive training, Bax said. "What we have here is not readily communicable to the wider community," he said.

And the complexity of heart disease and its treatment in many patients will inevitably limit the use of the method, one U.S. expert said.

The Dutch cardiologists used a multislice computed tomography scanner that provides a 64-slice image of the heart. They tested the prowess of the machine on 182 patients who had been given stents -- tiny mesh tubes -- to prop open a total of 192 arteries and who were scheduled to have angiography six months later, either as a routine follow-up or because of symptoms suggesting that a stent had narrowed or closed.

All underwent multislice computed tomography scans (MSCT), followed by invasive angiography a few days later. Angiography showed significant narrowing or closure of 20 stents, and MSCT correctly detected 19 of them. MSCT also correctly showed no significant problem in 147 of the 158 stents given a clean bill of health by angiography -- a success rate of 99 percent.

The study is published in the June 5 issue of the Journal of the American College of Cardiology.

"The implication of this finding is that if a narrowing is not detected, it is unlikely to be present, which potentially could avoid unnecessary catheterizations," said Dr. Gilbert Raff, director of the Ministrelli Center for Advanced Cardiovascular Imaging at William Beaumont Hospital in Royal Oak, Mich.

"But my own feeling is that if you have a patient with a stent and want to know whether the stent is open, the first step should be a stress test," he said.

Multislice computed tomography scans might be good at showing whether an individual stent is open or blocked, "but most patients who have stents have cardiovascular disease in a number of locations," Raff said. "If they present with symptoms, a stress test can give you a pretty good idea of whether a stent is responsible."

The MSCT technique could be valuable in some cases, Raff said. "My conclusion was that if the patient had a single stent in a major branch of an artery, it would be useful," he said. "But a typical patient who gets stents has four or five stents in different areas. If the patient presents with chest pain or back pain, I would say get a stress test first. If the stress test was normal, I'm not sure MSCT would be the thing to do. If the stress test was abnormal, then you could do catheterization or MSCT. If it were single-vessel disease, that might be helpful."

Multislice computed tomography scans might also be useful in cases where the problem was more subtle, with narrowing of the stent, Raff said. The Dutch cardiologists aren't the only ones working to advance the technique, he noted; a group in Japan has reported similar results.

"That is where the technology is pushing the edge," Raff said. "But if the problem is in many vessels, not just one, this is not the technique of choice."

SOURCES: Jeroen J. Bax, M.D., professor of cardiology, Leiden University Medical Center, the Netherlands; Gilbert Raff, M.D., director, Ministrelli Center for Advanced Cardiovascular Imaging, William Beaumont Hospital, Royal Oak, Mich.; June 5, 2007, Journal of the American College of Cardiology
Publish Date: May 30, 2007

Bariatric surgery is meant to help people lose weight by shrinking the size of their stomach in order to reduce their intake of food and calories. The Teen Longitudinal Assessment of Bariatric Surgery (LABS) study, conducted by a team at the U.S. National Institutes of Health (NIH), will examine whether this is an appropriate treatment option for overweight teens.

Over the next five years, the study will enroll 200 teens scheduled for bariatric surgery and compare them to 200 adult bariatric surgery patients who've been obese since they were teens. All the participants will be followed for two years after the surgery.

Teens ages 14-19 are eligible for the study, but researchers may allow younger patients to enroll if they meet the criteria.

"The reasons for weight gain are complex and multifactorial, influenced by genetics, environment, eating and physical activity habits, and society. The information gathered from Teen-LABS will help determine if adolescence is the best time to intervene with this surgical therapy," Dr. Thomas Inge, chair, Teen-LABS and principal investigator for the Data Coordinating Center and Clinical Center at Cincinnati Children's Hospital Medical Center, said in a prepared statement.

Almost 17 percent of young people ages 6-19 in the United States are overweight, according to recent statistics.

SOURCE: U.S. National Institutes of Health, news release, May 2007
Publish Date: May 29, 2007