Here are what the editors at HealthDay consider to be the most important developments in Pathology for January 2017. This roundup includes the latest research news from journal articles, as well as the FDA approvals and regulatory changes that are the most likely to affect clinical practice.
Diabetes Mellitus Prevalence Higher in HIV-Infected Adults
TUESDAY, Jan. 31, 2017 (HealthDay News) — HIV-infected adults have diabetes mellitus (DM) prevalence of 10.3 percent, which is higher than general population adults, according to a study published in the January issue of BMJ Open Diabetes Research & Care.
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BMSC-Derived Exosomes Promote Retinal Ganglion Cell Survival
TUESDAY, Jan. 31, 2017 (HealthDay News) — Bone marrow-derived mesenchymal stem cell (BMSC)-derived exosomes promote retinal ganglion cell (RGC) survival, according to a study published online Jan. 26 in Stem Cells Translational Medicine.
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Quenched Activity-Based Probe Imaging Beneficial in NMSC
MONDAY, Jan. 30, 2017 (HealthDay News) — Quenched activity-based probe imaging can discriminate cancer from normal appearing skin tissue, according to a study published in the February issue of the Journal of the American Academy of Dermatology.
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Pre-Transplant Depression May Impair Post-HCT Outcomes
MONDAY, Jan. 30, 2017 (HealthDay News) — For adult patients undergoing hematopoietic cell transplantation (HCT), pre-transplant depression is associated with worse post-transplantation outcomes, according to a study published online Jan. 19 in Cancer.
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Hypoglycemia Induces Pro-Inflammatory Functional Changes
MONDAY, Jan. 30, 2017 (HealthDay News) — Hypoglycemia can promote mobilization of specific subsets of leukocytes and induce pro-inflammatory functional changes in immune cells, according to a study published online Jan. 23 in Diabetes.
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Microbiota Transfer Therapy Could Help Children With Autism
FRIDAY, Jan. 27, 2017 (HealthDay News) — A new approach to alter the gut microbiome and virome may be an effective treatment for children with autism spectrum disorder (ASD), according to research published online Jan. 23 in Microbiome.
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Rates of Heart Failure Rising in the United States
FRIDAY, Jan. 27, 2017 (HealthDay News) — Heart failure rates are increasing in the United States, and cardiovascular disease remains the leading cause of death, even as the mortality rate from cardiovascular disease is falling, according to a new report from the American Heart Association (AHA).
Antibiotics, Not Poor Hygiene, Main Cause of C. difficile Outbreak
FRIDAY, Jan. 27, 2017 (HealthDay News) — Reducing the use of fluoroquinolones has curbed an outbreak of Clostridium difficile that began in 2006 in England, according to a study published online Jan. 24 in The Lancet Infectious Diseases.
Risk of Diabetes Down With HCV SVR in HIV/HCV Coinfection
FRIDAY, Jan. 27, 2017 (HealthDay News) — In patients co-infected with HIV and hepatitis C virus (HCV), eradication of HCV is associated with a reduction in the risk of diabetes mellitus, according to a study published online Jan. 21 in Hepatology.
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Anxiety, Depression May Up Mortality Risk for Some Cancers
THURSDAY, Jan. 26, 2017 (HealthDay News) — Anxiety and depression may increase the risk of death from certain cancers, according to research published online Jan. 25 in The BMJ.
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Universal CAR T-Cell Therapy Helped Treat ALL in Two Infants
THURSDAY, Jan. 26, 2017 (HealthDay News) — Two infants with B-cell acute lymphoblastic leukemia (ALL) are in remission after treatment with genetically modified immune system cells, according to a report on the two cases published in the Jan. 25 issue of Science Translational Medicine.
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hCG Reduces Caspase-3-Dependent IL-16 Expression
THURSDAY, Jan. 26, 2017 (HealthDay News) — Human pregnancy hormone chorionic gonadotropin (hCG) triggers immune suppression by attenuating the processing and release of Caspase-3-dependent interleukin (IL)-16, according to a study published online Jan. 21 in Hepatology.
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Serum Trypsinogen Levels Down in Type 1 Diabetes
THURSDAY, Jan. 26, 2017 (HealthDay News) — Patients with type 1 diabetes have significantly lower serum trypsinogen levels than those without type 1 diabetes, according to a study published online Jan. 23 in Diabetes Care.
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Most PCPs Oppose Complete Repeal of the Affordable Care Act
THURSDAY, Jan. 26, 2017 (HealthDay News) — A majority of primary care doctors oppose full repeal of the Affordable Care Act, according to a perspective piece published online Jan. 25 in the New England Journal of Medicine.
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Overall Cancer Mortality Rate Down in the United States
WEDNESDAY, Jan. 25, 2017 (HealthDay News) — While cancer mortality rates have dropped 20 percent overall in the United States since 1980, high mortality rates persist in pockets throughout the country, according to a report published in the Jan. 24/31 issue of the Journal of the American Medical Association.
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Gene May ID Patients Needing Higher Doses of Methadone
TUESDAY, Jan. 24, 2017 (HealthDay News) — A genetic variant associated with opioid addiction may lead to personalized treatment for the condition, according to research published online Jan. 24 in Molecular Psychiatry.
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Catheter Safeguards at Hospitals Cut Bloodstream Infection Rates
TUESDAY, Jan. 24, 2017 (HealthDay News) — Improved catheter safety measures in hospitals significantly reduce bloodstream infections and health care costs, according to a review published recently in JAMA Internal Medicine.
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Cervical Cancer Mortality Higher Among Older, Black Women
MONDAY, Jan. 23, 2017 (HealthDay News) — The number of women who die from cervical cancer in the United States may be higher than previously believed, and the risk is greatest among older and black women, according to a study published online Jan. 23 in Cancer.
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Blood Test May Predict Survival for Patients With Ebola
MONDAY, Jan. 23, 2017 (HealthDay News) — A blood test may help determine a patient’s chance of surviving Ebola infection, according to a study published online Jan. 19 in Genome Biology.
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Many Advanced NSCLC Patients Not Getting Helpful Treatment
MONDAY, Jan. 23, 2017 (HealthDay News) — Many U.S. patients with late-stage non-small-cell lung cancer (NSCLC) do not receive treatments that could prolong their lives, according to a study published online Jan. 18 in the Journal of Thoracic Oncology.
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Multi-Parametric MRI Shows Benefit As Triage Test
MONDAY, Jan. 23, 2017 (HealthDay News) — For men with high serum prostate-specific antigen, multi-parametric magnetic resonance imaging (MP-MRI) is more sensitive but less specific than transrectal ultrasound guided prostate biopsy (TRUS-biopsy) for detecting clinically significant cancer, and can be used as a triage test to avoid unnecessary biopsy, according to a study published online Jan. 19 in The Lancet.
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Anti-Müllerian Hormone Predicts Menopause in Women With HIV
MONDAY, Jan. 23, 2017 (HealthDay News) — For HIV-infected women, anti-müllerian hormone is associated with age of menopause onset, according to a study published in the January issue of the American Journal of Obstetrics & Gynecology.
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Obesity Underrepresented in Medical Licensing Exams
FRIDAY, Jan. 20, 2017 (HealthDay News) — The most important concepts of obesity prevention and treatment are not adequately represented on the U.S. Medical Licensing Examination (USMLE) Step examinations, according to a study published recently in Teaching and Learning in Medicine.
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Early Study Results Promising for Genital Herpes Vaccine
FRIDAY, Jan. 20, 2017 (HealthDay News) — A new vaccine for herpes simplex virus type 2 could be nearing human clinical trials, according to research published online Jan. 19 in PLOS Pathogens.
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Type 1 Diabetes Tied to Gut Inflammation, Microbiota
FRIDAY, Jan. 20, 2017 (HealthDay News) — Patients with type 1 diabetes exhibit inflammation in the digestive tract and gut bacteria in a pattern that differs from individuals who do not have diabetes or those who have celiac disease, according to a study published online Jan. 19 in the Journal of Clinical Endocrinology & Metabolism.
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Hydrolyzed Cow’s Milk Formula May Up Islet Autoimmunity
FRIDAY, Jan. 20, 2017 (HealthDay News) — Use of hydrolyzed cow’s milk-based formula introduced during the first seven days is associated with increased risk of islet autoimmunity in infants at increased risk of type 1 diabetes (T1D), according to a study published online Jan. 17 in Diabetes Care.
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Iatrogenic Cushing’s Syndrome Described in 9-Year-Old Girl
FRIDAY, Jan. 20, 2017 (HealthDay News) — In a case report published online Jan. 19 in Pediatrics, iatrogenic Cushing’s syndrome (CS) is described in a 9-year-old girl who received topical ocular glucocorticoid (GC) treatment for bilateral iridocyclitis.
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Sedentary Behavior May Lead to Shorter Telomeres in Women
THURSDAY, Jan. 19, 2017 (HealthDay News) — A sedentary lifestyle may accelerate biological aging, according to a study published online Jan. 18 in the American Journal of Epidemiology.
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Grilled, Smoked Meats May Up Mortality Risk After Breast Cancer
THURSDAY, Jan. 19, 2017 (HealthDay News) — Research has suggested that diets high in barbecued, grilled, and smoked meats could increase the risk of breast cancer. Now, a new study finds these cooking methods may also lower survival after a breast cancer diagnosis. The findings have been published online Jan. 4 in the Journal of the National Cancer Institute.
Genital HPV Prevalence Rate High Among Men in the United States
THURSDAY, Jan. 19, 2017 (HealthDay News) — Nearly half of American men may be infected with human papillomavirus (HPV), and HPV vaccination coverage is low among vaccine-eligible men, according to a study published online Jan. 19 in JAMA Oncology.
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Biomarkers, Clinical Risk Improve Prediction of Renal Function
THURSDAY, Jan. 19, 2017 (HealthDay News) — For patients with type 2 diabetes and chronic kidney disease (CKD), a set of nine molecular biomarkers together with clinical risk factors enhances prediction of renal function loss, according to a study published online Jan. 11 in Diabetes Care.
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Effectiveness of One-Dose MenACWY-D Drops Over Time
THURSDAY, Jan. 19, 2017 (HealthDay News) — For adolescents, the effectiveness of the one-dose meningococcal (groups A, C, W, and Y) polysaccharide diphtheria toxoid conjugate vaccine (MenACWY-D) decreases at three to less than eight years post-vaccination, according to a study published online Jan. 18 in Pediatrics.
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Experimental Drug May Simplify Macular Degeneration Treatment
THURSDAY, Jan. 19, 2017 (HealthDay News) — An experimental drug, AXT107, may one day make treatment simpler for patients with age-related macular degeneration, according to research published in the Jan. 18 issue of Science Translational Medicine.
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CpG Island Methylator Phenotype Prognostic After CRC Surgery
THURSDAY, Jan. 19, 2017 (HealthDay News) — For patients undergoing colorectal cancer (CRC) surgery, CpG island methylator phenotype (CIMP) status predicts survival, according to research published online Jan. 14 in the Journal of Gastroenterology and Hepatology.
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Recommendations Developed for Small Renal Mass Management
WEDNESDAY, Jan. 18, 2017 (HealthDay News) — In a clinical practice guideline published online Jan. 16 in the Journal of Clinical Oncology, recommendations are presented for the management of patients with small renal masses (SRMs).
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Brief Bouts of Exercise Can Reduce Inflammation
WEDNESDAY, Jan. 18, 2017 (HealthDay News) — Just 20 minutes of moderate exercise may reduce inflammation in the body, according to research published online recently in Brain, Behavior, and Immunity.
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Metabolites Linked to Renal Decline, Time to ESRD in T1DM
WEDNESDAY, Jan. 18, 2017 (HealthDay News) — Serum levels of seven modified metabolites are associated with renal function decline and time to end-stage renal disease (ESRD) among patients with type 1 diabetes (T1D), according to a study published online Jan. 13 in Diabetes Care.
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Hypertension Onset After Age 80 May Protect Against Dementia
WEDNESDAY, Jan. 18, 2017 (HealthDay News) — Developing hypertension in very old age may provide some protection from dementia, according to a study published online Jan. 17 in Alzheimer’s & Dementia.
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Physician Excess Charges Create Financial Burden for Patients
TUESDAY, Jan. 17, 2017 (HealthDay News) — Many doctors bill their private-paying patients two, three, even six times more than what Medicare pays for the same services, according to a research letter published in the Jan. 17 issue of the Journal of the American Medical Association.
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Syphilis Risk May Be Higher in HIV Patients on Antiretrovirals
TUESDAY, Jan. 17, 2017 (HealthDay News) — Men who have sex with men (MSM) receiving antiretroviral therapy (ART) to treat HIV infection may be at increased risk for syphilis, according to research published online Jan. 16 in Sexually Transmitted Infections.
Unique Molecular Features for Vulvar, Vaginal Melanomas
TUESDAY, Jan. 17, 2017 (HealthDay News) — Vulvar and vaginal melanomas (VVMs) have unique molecular features as compared to nongynecologic melanoma (NGM), according to a study published online Dec. 27 in Cancer.
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Carbapenem-Resistant Bacteria More Problematic Than Thought
TUESDAY, Jan. 17, 2017 (HealthDay News) — Carbapenem-resistant Enterobacteriaceae (CRE) is more widespread in U.S. hospitals than previously thought and needs to be more closely monitored, according to a study published online Jan. 16 in the Proceedings of the National Academy of Sciences.
Interaction Between Antibiotics, Obesity Is Complex
TUESDAY, Jan. 17, 2017 (HealthDay News) — The interaction between antibiotics and human growth and obesity is explored in a historical perspective piece published in the Jan. 17 issue of the Annals of Internal Medicine.
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Caffeine Found to Reduce Age-Related Inflammation
MONDAY, Jan. 16, 2017 (HealthDay News) — Caffeine may help reduce the type of inflammation that’s linked to cardiovascular disease risk factors, according to a study published online Jan. 16 in Nature Medicine.
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BNP, Gal-3 Levels Predict 60-Day Readmission in Heart Failure
MONDAY, Jan. 16, 2017 (HealthDay News) — For patients with acute decompensated heart failure (ADHF), measurement of B-type natriuretic peptide (BNP) and galectin-3 (Gal-3) before discharge can predict hospital readmission within 60 days, according to a study published in the Feb. 1 issue of The American Journal of Cardiology.
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Procalcitonin Testing on ICU Admission Linked to Lower LOS
MONDAY, Jan. 16, 2017 (HealthDay News) — For patients admitted to the intensive care unit (ICU), procalcitonin (PCT) testing on the first day of admission is associated with significantly lower length stay in the hospital and ICU, according to a study published in the January issue of CHEST.
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Harmonized Normal Range of Testosterone Established
MONDAY, Jan. 16, 2017 (HealthDay News) — In non-obese European and American men, aged 19 to 39 years, the harmonized normal range of testosterone is 264 to 916 ng/dL (2.5th to 97.5th percentile), according to a study published online Jan. 10 in the Journal of Clinical Endocrinology & Metabolism.
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Pace of Influenza Activity Picking Up Across the United States
FRIDAY, Jan. 13, 2017 (HealthDay News) — The pace of flu activity continues to quicken across the United States, and probably hasn’t peaked yet, according to an assessment by the U.S. Centers for Disease Control and Prevention.
Tapeworm From Asian Waters Identified in Alaskan Salmon
FRIDAY, Jan. 13, 2017 (HealthDay News) — A tapeworm known to infect salmon from the Asian Pacific is also present in fish from U.S. waters, according to research published in the February issue of the U.S. Centers for Disease Control and Prevention’s Emerging Infectious Diseases.
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First U.S. Case of Locally Acquired Zika Described
THURSDAY, Jan. 12, 2017 (HealthDay News) — In a case study from the University of Miami, and published online Jan. 11 in the New England Journal of Medicine, doctors provide new insight into the Zika virus, showing fetal exposure doesn’t necessarily mean infection.
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CDC: Higher Risk of Death From Leading Causes in Rural America
THURSDAY, Jan. 12, 2017 (HealthDay News) — Americans who live in rural areas have a higher risk of death from five leading causes than people who live in urban locations, according to research published in the Jan. 13 issue of the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.
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New Comprehensive Report Looks at Benefits, Harms of Cannabis
THURSDAY, Jan. 12, 2017 (HealthDay News) — Current medical science has proven there are legitimate medical uses for marijuana and cannabis-derived drugs, according to a new report — The Health Effects of Cannabis and Cannabinoids — published Jan. 12 by the National Academy of Sciences, Engineering, and Medicine.
Low Serum Vitamin D Linked to Frequent Headache in Men
THURSDAY, Jan. 12, 2017 (HealthDay News) — Low serum 25-hydroxyvitamin D (25[OH]D) is associated with frequent headache in middle-aged and older men, according to a study published online Jan. 3 in Scientific Reports.
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Gut Metabolite May Help Predict Cardiovascular Mortality Risk
WEDNESDAY, Jan. 11, 2017 (HealthDay News) — A metabolite produced in the digestion of red meat, eggs, and dairy products — trimethylamine N-oxide (TMAO) — is linked to an increased risk of a fatal myocardial infarction or stroke, according to a study published online Jan. 11 in the European Heart Journal.
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Global Rates of Hypertension on the Rise
WEDNESDAY, Jan. 11, 2017 (HealthDay News) — The global rate of hypertension and prehypertension rose significantly between 1990 and 2015, according to a report published in the Jan. 10 issue of the Journal of the American Medical Association.
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CDC: Renal Failure From Diabetes Declining in Native Americans
WEDNESDAY, Jan. 11, 2017 (HealthDay News) — Diabetes-related end-stage renal disease among Native American adults fell by more than half over almost 20 years, according to research published in the Jan. 10 early-release issue of the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.
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Tobacco Control Plays Key Role in Saving Both Lives and Dollars
WEDNESDAY, Jan. 11, 2017 (HealthDay News) — Smoking kills about six million people a year, and costs the world more than $1 trillion a year in health care expenses and lost productivity, but billions of dollars and millions of lives could be saved through higher tobacco prices and taxes, according to a report from the World Health Organization and the U.S. National Cancer Institute.
Enteroviruses May Be Linked to Autoimmunity Leading to T1DM
TUESDAY, Jan. 10, 2017 (HealthDay News) — Enteroviruses may play a role in the development of at least some cases of type 1 diabetes, according to a study published online Jan. 9 in Diabetologia.
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Ocean Conditions Tied to Higher Risk of Toxic Shellfish
TUESDAY, Jan. 10, 2017 (HealthDay News) — Unusually warm ocean temperatures near the U.S. Pacific Northwest have been linked to dangerous levels of a natural toxin in shellfish; however, scientist have developed new ways to predict these toxic outbreaks, according to research published online Jan. 9 in the Proceedings of the National Academy of Sciences.
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Mathematical Model Can Simulate HbA1c Progression in T2DM
TUESDAY, Jan. 10, 2017 (HealthDay News) — A mathematical model (MM) can simulate hemoglobin A1c (HbA1c) trajectories in type 2 diabetes mellitus (T2DM) models, according to a study published online Dec. 27 in Diabetes, Obesity and Metabolism.
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Diabetes May Impair Myocardial Proangiogenic Response
MONDAY, Jan. 9, 2017 (HealthDay News) — The amplitude of therapeutic revascularization associated with recombinant adeno-associated virus (rAAV) (5 × 1012 viral particles encoding thymosin beta 4 [Tβ4]) is reduced with diabetes mellitus, according to an experimental study published in the Jan. 17 issue of the Journal of the American College of Cardiology.
GSK3 Antagonists Promote Natural Tooth Repair in Mice
MONDAY, Jan. 9, 2017 (HealthDay News) — Teeth might someday repair themselves using their own stem cells — eliminating the need for conventional fillings, according to an experimental study published online Jan. 9 in Scientific Reports.
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Adipose Tissue Insulin Resistance Up in Obese-NGT, IGT, T2DM
MONDAY, Jan. 9, 2017 (HealthDay News) — Resistance to the antilipolytic effect of insulin (Adipo-IR) is increased in obese individuals with normal glucose tolerance (NGT), and in those with impaired glucose tolerance (IGT) and type 2 diabetes (T2DM), according to a study published online Jan. 4 in Diabetes.
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Clinical Features of Vitiligo Linked to Age of Disease Onset
MONDAY, Jan. 9, 2017 (HealthDay News) — The clinical features of vitiligo are associated with age of disease onset, according to a study published online Jan. 4 in the International Journal of Dermatology.
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Ivermectin Has Topical Anti-Inflammatory Properties
MONDAY, Jan. 9, 2017 (HealthDay News) — Ivermectin (IVM) has anti-inflammatory properties that could be beneficial in treatment of T-cell mediated skin inflammatory diseases, according to an experimental study published online Jan. 4 in Allergy.
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Acid Suppression Rx Linked to Risk of C. difficile, Campylobacter
FRIDAY, Jan. 6, 2017 (HealthDay News) — Proton pump inhibitor (PPI) and H2 receptor antagonist (H2RA) users may be at higher risk of infection with Clostridium difficile and Campylobacter bacteria, according to a study published online Jan. 5 in the British Journal of Clinical Pharmacology.
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Running May Actually Lower Inflammation in Knee Joints
FRIDAY, Jan. 6, 2017 (HealthDay News) — Running might actually reduce inflammation in knee joints, according to research published recently in the European Journal of Applied Physiology.
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Fibromyalgia Symptoms Improve With CoQ10 Supplementation
FRIDAY, Jan. 6, 2017 (HealthDay News) — For patients with fibromyalgia (FM), coenzyme Q10 (CoQ10) supplementation is associated with improvement in clinical symptoms, according to a letter to the editor published online Jan. 4 in CNS Neuroscience & Therapeutics.
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GlycA Linked to Insulin Sensitivity, Independent of CRP
FRIDAY, Jan. 6, 2017 (HealthDay News) — N-acetylglucosamine/galactosamine (GlycA) is associated with insulin sensitivity, independent of C-reactive protein (CRP), according to a study published online Dec. 28 in Diabetes Care.
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Cancer Mortality Rates Continue to Decline in the United States
THURSDAY, Jan. 5, 2017 (HealthDay News) — Cancer mortality rates in the United States have dropped 25 percent since the early 1990s, according to a new report published online Jan. 5 in CA: A Cancer Journal for Clinicians.
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Dementia Risk Up for Those Living Near Major Roads
THURSDAY, Jan. 5, 2017 (HealthDay News) — People who live relatively close to busy traffic have a slightly higher risk for dementia, according to research published online Jan. 4 in The Lancet.
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Meta-Analysis Links Omega-3 Fatty Acid Consumption to T2DM
THURSDAY, Jan. 5, 2017 (HealthDay News) — Consumption of single omega-3 is associated with an increased risk of type 2 diabetes (T2D), with dosage, ethnicity, trial duration, and recruited age influencing the effect, according to a meta-analysis published online Dec. 29 in the Journal of Diabetes Investigation.
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Some Apolipoproteins Linked to Incident Type 2 Diabetes
THURSDAY, Jan. 5, 2017 (HealthDay News) — Apolipoprotein (apo) CIII and apoCIII-to-apoA1 ratio are correlated with incident type 2 diabetes (T2D), according to a study published online Dec. 28 in Diabetes Care.
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Interface Between Allergy, Oncology Explored
WEDNESDAY, Jan. 4, 2017 (HealthDay News) — The interface between allergic responses and oncology is being explored, which may have implications for treatment, according to a European Academy of Allergy and Clinical Immunology position paper published online Dec. 29 in Allergy.
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Anterior T-Wave Inversion in 2.3 Percent of Healthy Young Adults
WEDNESDAY, Jan. 4, 2017 (HealthDay News) — Anterior T-wave inversion (ATWI) occurs in 2.3 percent of young asymptomatic adults, usually in leads V1 and V2, according to a study published in the Jan. 3/10 issue of the Journal of the American College of Cardiology.
New Model IDs Inflammatory Asthma Without Sputum
WEDNESDAY, Jan. 4, 2017 (HealthDay News) — A new prediction model identifies eosinophilic asthma without the need for sputum induction, according to a study published online Dec. 28 in Allergy.
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Major Zika Outbreak Considered Unlikely in the United States
TUESDAY, Jan. 3, 2017 (HealthDay News) — The Zika virus is not likely to gain a foothold in the United States as it did in Brazil and other Latin American countries, according to a report published in the Jan. 3 issue of the Journal of Medical Entomology.
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Sex Hormone-Sensitive Gene Complex Implicated in PMDD
TUESDAY, Jan. 3, 2017 (HealthDay News) — The activity of certain genes are associated with premenstrual dysphoric disorder (PMDD), according to a study published online Jan. 3 in Molecular Psychiatry.
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Alcohol Abuse Ups Risk of Several Heart Conditions
TUESDAY, Jan. 3, 2016 (HealthDay News) — Alcohol abuse increases the risk of atrial fibrillation (AF), myocardial infarction (MI), and congestive heart failure (CHF) as much as other well-established risk factors, according to a study published in the Jan. 3/10 issue of the Journal of the American College of Cardiology.
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