Abstract
To quantify the association between high-density lipoprotein (HDL) subfractions, efflux capacity, and inflammatory markers at baseline and the effect of supervised exercise on these HDL parameters in patients with peripheral artery disease (PAD). The study to improve leg circulation (SILC) was a randomized trial of supervised treadmill exercise, leg resistance training, or control in individuals with PAD. In a post hoc cross-sectional analysis, we quantified the associations between baseline HDL subfraction concentrations (HDL2 and HDL3), HDL-C efflux capacity, and inflammatory markers [C-reactive protein (CRP) and interleukin-6 (IL-6)]. We then examined the effect of supervised exercise on changes in these lipoprotein parameters and inflammatory markers in 88 patients from SILC. Baseline HDL-C efflux capacity was associated with baseline concentrations of HDL2 (β = 0.008, p = 0.0106), HDL3 (β = 0.013, p < 0.0001), and IL-6 (β = -0.019, p = 0.03). Baseline HDL3 concentration was inversely associated with IL-6 concentration (β = -0.99, p = 0.008). Compared to control, changes in HDL2, HDL3, normalized HDL-C efflux capacity, CRP, or IL-6 were not significantly different at 6 months following the structured exercise intervention. HDL efflux and HDL3 were inversely associated with IL-6 in PAD patients. Structured exercise was not associated with changes in HDL subfractions, HDL-C efflux capacity, CRP, and IL-6 in PAD patients. Our preliminary findings support the theory that inflammation may adversely affect HDL structure and function; however, further studies are needed to evaluate these findings.
Highlights
In a post hoc cross-sectional analysis, we quantified the associations between baseline high-density lipoprotein (HDL) subfraction concentrations (HDL2 and high-density lipoprotein-3 cholesterol (HDL3)), HDL-C efflux capacity, and inflammatory markers [C-reactive protein (CRP) and interleukin-6 (IL-6)]
Exercise has been observed to alter high-density lipoprotein (HDL) metrics associated with the risk of cardiovascular disease (CVD), including increased HDL subfractions [1] in individuals without known CVD and increased HDL-C efflux capacity in observational studies of athletes [2, 3]
Our results show that supervised strength and treadmill exercise training are not associated with changes in HDL subfractions, cholesterol efflux capacity, or inflammatory markers in patients with peripheral artery disease (PAD)
Summary
Exercise has been observed to alter high-density lipoprotein (HDL) metrics associated with the risk of cardiovascular disease (CVD), including increased HDL subfractions [1] in individuals without known CVD and increased HDL-C efflux capacity in observational studies of athletes [2, 3]. Exercise [4] and physical activity [5] may be associated with reductions in levels of inflammatory markers, including C-reactive protein (CRP) and interleukin-6 (IL-6), which could slow disease progression, functional decline, and reduce risks for cardiovascular outcomes in PAD patients [6,7,8]. High-density lipoprotein structure (as measured by subfraction concentration) is associated with CVD risk [15, 16], and measurement of HDL function (as measured by HDL-C efflux capacity) has emerged as a robust marker of prevalent and incident CVD [17]. The effect of supervised exercise on HDL subfraction concentration and HDL efflux capacity in patients with PAD has not been studied
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