Effect of strenuous exercise on mediators of inflammation in patients with coronary artery disease.

BACKGROUND: Coronary artery disease (CAD) is considered a low-grade inflammatory disease. We aimed to identify effects of short-term strenuous exercise on mediators of systemic inflammation, endothelial and platelet activation in patients with angiographically verified CAD. We hypothesized that a more pronounced inflammatory response would be present in patients with CAD than in those without CAD. METHODS: In subjects with symptoms indicative of stable CAD, an exercise stress test on a bicycle ergometer was performed. Venous blood samples, taken at rest and within 5 min after end of exercise, were analyzed for the following markers by ELISAs: TNF-α, IL-6, MCP-1, ICAM-1, VCAM-1, E-selectin, P-selectin, CD40L and RANTES. All participants underwent conventional coronary angiography. CAD was defined as having any degree of atherosclerosis. RESULTS: A total of 110 patients were included, of whom 74 were found to have CAD. Mean exercise duration was 10:06 ±â€¯3:56 min with no significant difference between the two groups. All measured markers changed significantly during exercise (p ≤ 0.012). A significantly less pronounced increase in CD40L in the CAD group than in the no CAD group was observed (p = 0.050), however, after adjustment for hematocrit this difference was no longer significant. CONCLUSION: An instant inflammatory response was observed during short-term strenuous exercise in patients with symptoms of CAD. However, the exercise mediated response was not more pronounced in patients with CAD.

Pro-coagulant activity during exercise testing in patients with coronary artery disease.

BACKGROUND: Strenuous exercise may trigger myocardial infarction through increased pro-coagulant activity. We aimed to investigate whether patients referred for exercise testing, who were found to have angiographically verified coronary artery disease (CAD), have a more hypercoagulable profile during exercise testing than those without CAD. METHODS: Patients with symptoms of stable CAD were examined with exercise electrocardiography on bicycle ergometer. Venous blood samples were taken at rest and within 5 min after end of exercise. The following haemostatic variables were analyzed: tissue factor pathway inhibitor (TFPI) activity and antigen, prothrombin fragment 1 + 2 (F1 + 2), D-dimer and endogenous thrombin potential (ETP). All participants underwent conventional coronary angiography. CAD was defined as having any degree of atherosclerosis. RESULTS: Out of the 106 patients enrolled, 70 were found to have CAD. Mean exercise duration was 10:06 ± 4:11 min, with no significant differences between the groups. A significant increase from baseline to after exercise testing was observed in all measured markers in the total population (p ≤ 0.002 for all). In patients with angiographically verified CAD, total TFPI was significantly lower at baseline compared to patients without CAD (median value 67.4 and 76.6 ng/ml respectively, p = 0.027). However, no significant differences in changes of any of the measured markers during exercise were observed between the two groups. CONCLUSION: Pro-coagulant activity increased during short-term strenuous exercise testing in patients with symptoms suggestive of CAD. However the hypercoagulable state observed, was not more pronounced in patients with angiographically verified CAD compared to patients without CAD. NCT01495091.