Short-term folinic acid supplementation and aerobic exercise improve vascular reactivity in HIV-infected individuals.

The aim of this study was to determine the effect of supervised exercise and folinic acid supplementation on endothelial function in HIV-infected individuals. A randomized clinical trial, double blinded, was conducted with 16 HIV-infected individuals, antiretroviral therapy (at least 6 months) with undetectable viral load (<50 copies/mL), and CD4 count > 200 cells/mm3. The subjects were randomized to aerobic exercise (n = 5) and daily intake for 4 weeks of 5 mg of folinic acid (n = 6) or placebo (n = 5) groups. To assess endothelial function, venous occlusion plethysmography in the brachial artery by the protocol of reactive hyperemia was performed. The aerobic protocol consisted in cycling exercise, 3 times/week at 60-80% VO2max, for 4 weeks. Exercise group (Δ6.5 mL/min/100 mL) and folinic acid group (Δ7.3 mL/min/100 mL) improved reactive hyperemia, but no difference was found in placebo group (from Δ -0.3 ml/min/100 ml, time p < 0.001, interaction p = 0.02). Results demonstrate that supervised exercise and folinic acid supplementation in very short term improve endothelial function in HIV-infected individuals. As exercise and folate supplementation are safe and relatively inexpensive, this finding deserves more attention in large randomized clinical trials in an attempt to reduce cardiovascular risk in HIV-infected population.

Short-term folinic acid supplementation improves vascular reactivity in HIV-infected individuals: a randomized trial.

OBJECTIVE: HIV-infected individuals present a cluster of conditions that activate or injure the vascular endothelium. The administration of folates may exert beneficial effects on endothelial function in different populations at risk for cardiovascular disease. The aim of this study was to determine the effects of 4 wk of folinic acid supplementation on forearm vascular responses during reactive hyperemia in HIV-infected patients under highly active antiretroviral therapy. METHODS: This was a prospective, randomized, double-blind, placebo-controlled trial to compare the effects of 4 wk of daily ingestion of 5 mg of folinic acid (n = 15) or placebo (n = 15). Participants had to have been on antiretroviral therapy (ART) for at least 6 mo before enrollment, with undetectable viral load, and CD4 cell count >200 cells/mm(3). Vascular function was evaluated with venous occlusion plethysmography at baseline and after 4 wk, for the determination of brachial artery reactive hyperemia, and after isosorbide dinitrate administration. RESULTS: The groups were comparable. The mean age of patients was 45 y; there were eight women in each group. There was no difference regarding ART regimen. The supplementation of folinic acid produced a significant improvement in reactive hyperemia (from 14.9 to 21.2 mL•min•100 mL). The same was not observed in placebo group (from 15.3 to 14.6 mL•min•100 mL; group P, 0.017; time P < 0.001; interaction P < 0.001). Endothelium-independent responses remained unchanged. CONCLUSIONS: Short-term folinic acid supplementation improved vascular reactivity in HIV-infected individuals enrolled in the studied. As folate supplementation is safe and relatively inexpensive, long-term clinical trials should be conducted.

Blunted local but preserved remote vascular responses after resistance exercise in chronic heart failure.

BACKGROUND: A single aerobic exercise session increases blood flow and vascular reactivity in remote vascular areas in chronic heart failure (CHF). We hypothesized that CHF patients would present increased vascular reactivity after a resistance exercise session. METHODS: Ten CHF patients and 10 healthy controls participated in three experiments, on different days: (1) 25-min rest (control); (2) 25-min lower-limb resistance exercises with vascular measurements in the calf (RELL); and (3) 25-min lower-limb resistance exercises with vascular measurements in the forearm (REUL). Heart rate (HR), blood pressure (BP), forearm blood flow (FBF), and calf blood flow (CBF) were measured at baseline, immediately, and 10, 30, and 60 min after the interventions. Calf and forearm reactive hyperaemia (RH) were measured at baseline and at 10, 30, and 60 min post interventions. RESULTS: Mean BP was unchanged throughout the protocols in CHF patients, whereas healthy controls had postexercise reduction up to 60 and 10 min after RELL and REUL sessions, respectively. Forearm RH (30- min post exercise) indicated remote effects and was increased by 36% and 43% (p < 0.05) in CHF patients and controls, respectively. Both groups increased postexercise calf RH (local effect) up to 60 min; however, healthy controls presented larger responses compared with patients (73% vs. 39%, p < 0.05). CONCLUSION: Patients with CHF present blunted vascular responses in the exercised areas, but remote vascular reactivity responses are similar to those observed in healthy individuals, suggesting that resistance exercise may remotely contribute to vascular adaptation in nontrained vasculatures.