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A randomised trial comparing the effect of exercise training and weight loss on microvascular function in coronary
Rasmus Huan Olsen1, Lene Rørholm Pedersen1, Anders Jürs1
1Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
Insights
Both aerobic interval training (AIT) and low energy diet (LED) significantly improved coronary flow reserve (CFR) in obese patients with coronary artery disease (CAD). These interventions may positively impact patient prognosis by enhancing coronary microvascular function.
Area of Science:
- Cardiology
- Exercise Physiology
- Vascular Biology
Background:
- Coronary microvascular function is a critical determinant of cardiovascular outcomes.
- Impaired coronary microvascular function is prevalent in patients with coronary artery disease (CAD) and obesity.
- The impact of lifestyle interventions on coronary microvascular function in this population remains incompletely understood.
Purpose of the Study:
- To compare the effects of aerobic interval training (AIT) and a low energy diet (LED) on coronary flow reserve (CFR).
- To evaluate the impact of these interventions on peripheral vascular function in obese patients with CAD.
- To assess the feasibility and efficacy of AIT and LED in a revascularised obese CAD patient cohort.
Main Methods:
- Seventy obese, non-diabetic CAD patients were randomized to either 12 weeks of AIT or a low energy diet (LED).
- Coronary flow reserve (CFR) was measured using Doppler echocardiography, and peripheral vascular function was assessed via arterial tonometry.
- Intervention adherence was defined by training attendance (≥60% for AIT) and weight loss (≥5% for LED).
Main Results:
- Both AIT and LED interventions led to significant improvements in CFR, with no significant difference between the groups.
- AIT increased cardiorespiratory fitness (VO2peak) by 10.4%, while LED resulted in a 10.6% weight loss.
- Peripheral vascular function, assessed by reactive hyperaemia index (RHI) and augmentation index, remained unchanged in both groups.
Conclusions:
- Twelve weeks of either AIT or LED can similarly enhance coronary microvascular function in obese CAD patients.
- Both interventions hold potential for improving prognosis in CAD patients by positively affecting coronary microvascular function.
- Further research is warranted to explore the long-term prognostic implications of these findings.
Background:
Coronary microvascular function is associated with outcome and is reduced in coronary artery disease (CAD) and obesity. We compared the effect of aerobic interval training (AIT) and weight loss on coronary flow reserve (CFR) and peripheral vascular function in revascularised obese CAD patients.
Methods And Results:
Seventy non-diabetic patients (BMI 28-40 kg × m(-2), age 45-75 years) were randomised to 12 weeks' AIT (three weekly sessions lasting 38 min with ≈ 16 min at 85-90% of VO2peak) or low energy diet (LED, 800-1000 kcal/day). Per protocol adherence was defined by training-attendance ≥ 60% and weight loss ≥ 5%, respectively. CFR was assessed by Doppler echocardiography of the LAD. Peripheral vascular function was assessed by arterial tonometry as reactive hyperaemia index (RHI) and augmentation index. Most participants had impaired CFR with a mean CFR of 2.38 (SD 0.59). Twenty-six AIT and 24 LED participants completed the study per protocol with valid CFR measurements. AIT resulted in a 10.4% improvement in VO2peak and LED in a 10.6% weight loss (between group differences both P<0.001). CFR increased by 0.26 (95%CI 0.04;0.48) after AIT and by 0.39 (95%CI 0.13;0.65) after LED without significant between-group difference (-0.13 (95%CI -0.45;0.20)). RHI and augmentation index remained unchanged after both interventions (P>0.50). Intention-to-treat analyses showed similar results.
Conclusions:
12 weeks' AIT and LED increased CFR by comparable magnitude; thus both interventions might impact prognosis of CAD through improvement of coronary microvascular function.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01724567.
