Vascular Function in Patients After Myocardial Infarction: The Importance of Physical Activity.

Jure Tršan,Uroš Rajkovič﻿﻿﻿,Marko Novaković﻿﻿﻿,Zlatko Fras,Daniel Košuta,Borut Jug

doi:10.3389/fphys.2021.763043

Abstract

Background: Patients after myocardial infarction have impaired vascular function. However, effects of lifestyle, e.g., physical activity level, on endothelial function and arterial stiffness remain scarce. The aim of our study was to investigate effects of physical activity level and risk factors on endothelial function and arterial stiffness.Methods: In this cross-sectional study, we ultrasonographically assessed parameters of vascular function, namely flow mediated dilation (FMD) of the brachial artery and carotid artery stiffness in patients after myocardial infarction referred to the cardiac rehabilitation. The International Physical Activity Questionnaire (IPAQ) was obtained from all participants. Based on the IPAQ, patients were classified into three groups: vigorous, moderate, and low physical activity engagement. ANOVA was used for comparison among three groups using Bonferroni correction to determine differences between two sub-groups.Results: One hundred and eight patients after myocardial infarction (mean age 53 ± 10 years) were included. There were significant differences in terms of FMD (8.2 vs. 4.2 vs. 1.9%, p < 0.001) and pulse wave velocity (PWV), a measure of arterial stiffness (6.1 vs. 6.4 vs. 6.9 m/s, p = 0.004) among groups of vigorous, moderate, and low physical activity engagement, respectively. However, in younger patients only FMD remained associated with physical activity level, while arterial stiffness was not. Low physical activity engagement was a significant predictor of both FMD and PWV in univariate and multivariate models, adjusted for age, sex, and other risk factors.Conclusion: Low physical activity level is associated with impaired endothelial function and increased arterial stiffness in patients after myocardial infarction. Future studies are warranted to address this issue in a context of cardiac rehabilitation protocols optimization in order to improve vascular function in these patients.

Highlights

Myocardial infarction is a terminal step in the atherosclerotic pathophysiology
According to the International Physical Activity Questionnaire (IPAQ) questionnaire, patients were divided into three groups: vigorous, moderate, and low physical activity engagement (Table 1)
We have shown that lower physical activity engagement is associated with more diminished vascular function, namely increased arterial stiffness and impaired endothelial function

Summary

Introduction

Myocardial infarction is a terminal step in the atherosclerotic pathophysiology It starts with the functional impairment (Poredoš, 2002; Davignon and Ganz, 2004) and leads to the structural changes, mostly in the coronary, carotid, and arteries of the lower extremities (Kaspar et al, 2019). Patients with established coronary artery disease, especially after myocardial infarction, in most cases already have impaired endothelial function, often determined as flow-mediated dilation (Erzen et al, 2007). On the other hand, is a measure of the elastic properties of the arteries and relative contribution of collagen and elastin It is consisted of the before mentioned functional changes, related to the flow mediated dilation (FMD), and of the structural changes, as a consequence of the extracellular matrix degeneration, collagen deposition, and elastin fragmentation, and to the diminished arterial elastic properties (10; Janić et al, 2014). The aim of our study was to investigate effects of physical activity level and risk factors on endothelial function and arterial stiffness

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Conclusion