Exercise Training Enhances Brachial Artery Endothelial Function, Possibly via Improved HDL-C, not LDL-C and TG, in Patients with Coronary Artery Disease: A Systematic Review and Meta-analysis.

IF 2.8 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiovascular Drugs Pub Date : 2025-01-19 DOI:10.1007/s40256-024-00716-7

Junghoon Lee, Minsoo Kang, Yoonjung Park

{"title":"Exercise Training Enhances Brachial Artery Endothelial Function, Possibly via Improved HDL-C, not LDL-C and TG, in Patients with Coronary Artery Disease: A Systematic Review and Meta-analysis.","authors":"Junghoon Lee, Minsoo Kang, Yoonjung Park","doi":"10.1007/s40256-024-00716-7","DOIUrl":null,"url":null,"abstract":"Background: It remains controversial whether exercise training (EX) improves vascular endothelial function (VEF) independent of lipoprotein changes even though these are therapeutic goals for coronary artery disease (CAD).Objective: The purpose of this study was to systematically review the effects of EX on VEF and blood lipid variables in patients with CAD.Methods: This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We searched five electronic databases (CINAHL, Embase, PubMed, SportDiscus, and Web of Science) until March 2024 for studies that met the following criteria: (i) patients with CAD aged ≥ 18 years; (ii) structured EX for ≥ 1 week in randomized or nonrandomized controlled studies; and (iii) measured brachial artery flow-mediated dilation (FMD) with or without blood lipid variables. We calculated effect sizes (ESs) and 95% confidence intervals (CIs) using a random-effects model and conducted subgroup analyses to identify the effect of training factors (duration, intensity, and weekly volume) on outcomes.Results: In total, 11 studies with 19 trials (629 patients, 60 ± 9 years) met the inclusion criteria. We conducted a separate meta-analysis for each of the four outcome measures: FMD (13 ESs), high-density lipoprotein-cholesterol (HDL-C; eight ESs), low-density lipoprotein cholesterol (LDL-C; eight ESs), and triglycerides (TGs; eight ESs). EX significantly increased FMD (mean ES 0.57; 95% CI 0.44-0.70; P < 0.001) and HDL-C levels (mean ES 0.25; 95% CI 0.12-0.39; P < 0.001) but had no effect on LDL-C and TG. Subgroup analyses for FMD found no significant variation in effect by training factor (duration, intensity, and weekly volume).Conclusion: EX improves VEF with increased HDL-C, but we found no changes in LDL-C and TG in patients with CAD, suggesting that HDL-C is preferentially associated with exercise-induced VEF improvement.","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":2.8000,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Cardiovascular Drugs","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s40256-024-00716-7","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: It remains controversial whether exercise training (EX) improves vascular endothelial function (VEF) independent of lipoprotein changes even though these are therapeutic goals for coronary artery disease (CAD).

Objective: The purpose of this study was to systematically review the effects of EX on VEF and blood lipid variables in patients with CAD.

Methods: This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We searched five electronic databases (CINAHL, Embase, PubMed, SportDiscus, and Web of Science) until March 2024 for studies that met the following criteria: (i) patients with CAD aged ≥ 18 years; (ii) structured EX for ≥ 1 week in randomized or nonrandomized controlled studies; and (iii) measured brachial artery flow-mediated dilation (FMD) with or without blood lipid variables. We calculated effect sizes (ESs) and 95% confidence intervals (CIs) using a random-effects model and conducted subgroup analyses to identify the effect of training factors (duration, intensity, and weekly volume) on outcomes.

Results: In total, 11 studies with 19 trials (629 patients, 60 ± 9 years) met the inclusion criteria. We conducted a separate meta-analysis for each of the four outcome measures: FMD (13 ESs), high-density lipoprotein-cholesterol (HDL-C; eight ESs), low-density lipoprotein cholesterol (LDL-C; eight ESs), and triglycerides (TGs; eight ESs). EX significantly increased FMD (mean ES 0.57; 95% CI 0.44-0.70; P < 0.001) and HDL-C levels (mean ES 0.25; 95% CI 0.12-0.39; P < 0.001) but had no effect on LDL-C and TG. Subgroup analyses for FMD found no significant variation in effect by training factor (duration, intensity, and weekly volume).

Conclusion: EX improves VEF with increased HDL-C, but we found no changes in LDL-C and TG in patients with CAD, suggesting that HDL-C is preferentially associated with exercise-induced VEF improvement.

查看原文本刊更多论文

运动训练可以提高冠状动脉疾病患者的肱动脉内皮功能，可能是通过改善HDL-C，而不是LDL-C和TG：一项系统回顾和荟萃分析。

背景：运动训练（EX）是否独立于脂蛋白改变而改善血管内皮功能（VEF）仍存在争议，尽管这些是冠状动脉疾病（CAD）的治疗目标。目的：本研究的目的是系统回顾EX对冠心病患者VEF和血脂变量的影响。方法：本研究遵循系统评价和荟萃分析的首选报告项目（PRISMA）声明。截至2024年3月，我们检索了五个电子数据库（CINAHL、Embase、PubMed、SportDiscus和Web of Science），寻找符合以下标准的研究：(i) CAD患者年龄≥18岁；（ii）随机或非随机对照研究中结构化EX≥1周；（iii）测量有或没有血脂变量的肱动脉血流介导的扩张（FMD）。我们使用随机效应模型计算效应量（ESs）和95%置信区间（ci），并进行亚组分析，以确定训练因素（持续时间、强度和每周量）对结果的影响。结果：共有11项研究19项试验（629例患者，60±9年）符合纳入标准。我们对四个结局指标分别进行了单独的荟萃分析：FMD （13 ESs）、高密度脂蛋白-胆固醇(HDL-C；8 ESs)，低密度脂蛋白胆固醇(LDL-C；8 ESs)和甘油三酯(tg；8 ESs)。EX显著增加FMD(平均ES 0.57；95% ci 0.44-0.70；P < 0.001)和HDL-C水平(平均ES 0.25；95% ci 0.12-0.39；P < 0.001)，但对LDL-C和TG无影响。对口蹄疫的亚组分析发现，不同训练因素（持续时间、强度和每周量）的效果没有显著差异。结论：EX可改善VEF并增加HDL-C，但我们发现CAD患者LDL-C和TG未发生变化，提示HDL-C优先与运动诱导的VEF改善相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

American Journal of Cardiovascular Drugs 医学-心血管系统

CiteScore

6.70

自引率

3.30%

发文量

审稿时长

>12 weeks

期刊介绍： Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents. Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations. The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.