Exercise Training Enhances Brachial Artery Endothelial Function, Possibly via Improved HDL-C, not LDL-C and TG, in Patients with Coronary Artery Disease: A Systematic Review and Meta-analysis.
Level 2 - randomized trial
Systematic review and meta-analysis of randomized and nonrandomized controlled trials
PubMed 39827449 · doi:10.1007/s40256-024-00716-7
What was done
Authors conducted a systematic review and meta-analysis adhering to PRISMA guidelines across five electronic databases up to March 2024. Studies were included if they enrolled patients aged ≥ 18 years with coronary artery disease (CAD), evaluated structured exercise training (EX) for ≥ 1 week in randomized or nonrandomized controlled trials, and measured brachial artery flow-mediated dilation (FMD) with or without lipid profiles (HDL-C, LDL-C, triglycerides [TGs]). Effect sizes (ESs) and 95% confidence intervals (CIs) were calculated using random-effects models, with subgroup analyses by exercise duration, intensity, and weekly volume.
What was found
Eleven studies comprising 19 trials (629 patients, mean age 60 ± 9 years) were included. Exercise significantly increased FMD (13 ESs; mean ES 0.57, 95% CI 0.44–0.70, P < 0.001) and HDL-C (8 ESs; mean ES 0.25, 95% CI 0.12–0.39, P < 0.001). Exercise had no significant effect on LDL-C (8 ESs) or TG (8 ESs). Subgroup analyses indicated that training duration, intensity, and weekly volume did not significantly alter the magnitude of FMD improvement.
Why it matters
This review indicates that exercise enhances vascular endothelial function in CAD patients in parallel with modest HDL-C increases, independent of changes in LDL-C or triglycerides.
Limits
The review included nonrandomized controlled studies alongside randomized trials, raising risk of bias. The total sample size (629 patients across 11 studies) was relatively small, and baseline lipid-lowering pharmacotherapies, long-term adherence, and hard clinical cardiovascular outcomes were not reported in the abstract.
Cited by
- supports Damage to the endothelium from cholesterol, hypertension, and smoking causes atherosclerotic disease, and endothelial function is improved by exercise training at any point in life.