Exercise and heart disease

Atherosclerotic coronary artery disease (CAD) is a leading cause of death in the United States. It accounts for myocardial infarction in approximately 1.5 million Americans annually and results in approximately 500,000 deaths yearly. Half of these deaths occur prior to patients being admitted to a hospital. A dramatic reduction in mortality related to atherosclerotic CAD has occurred in the last decade. This reduction has resulted from significant advances in both the medical and surgical management of this disease as well as from increased efforts to modify risk factors known to increase the likelihood of developing CAD. Modifiable risk factors include cigarette smoking, hypercholesterolemia, and hypertension. More recently, physical inactivity has been found to be a significant modifiable risk factor that can influence the development of CAD. This article reviews some of the observational data that support these conclusions, discusses the role of exercise in the prevention of CAD in select groups, and reviews some of the mechanisms by which exercise may modify the development of CAD.