Beneficial Effects of Supervised Exercise Therapy on Modifiable Cardiovascular Risk Factors in Intermittent Claudication: A Systematic Review and Meta-analysis

Jansen, Sandra; Hoorweg, Beatrijs B. N.; Hoeks, Sanne E.; Houten, Marijn van den; Scheltinga, Marc R.; Teijink, Joep A.W.; Rouwet, Ellen V.

doi:10.1016/j.ejvs.2019.06.1224

Cited by 4 publications

(4 citation statements)

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“…intensive physical activity in men. It is well known that supervised exercise therapy contributes to significantly lower LDL-C and total cholesterol levels [38], and thus the reduction of PCSK9 levels in response to high physical activity may contribute to the final lipid-lowering effect.…”

Section: Discussionmentioning

confidence: 99%

Sex-specific predictors of PCSK9 levels in a European population: The IMPROVE study

et al. 2020

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Background and aims: Proprotein convertase subtilisin/kexin type 9 (PCSK9) is one of the key regulators of lowdensity lipoprotein cholesterol plasma levels. Circulating PCSK9, which differs between genders, represents a valid pharmacological target for preventing cardiovascular (CV) events. We aimed to investigate sex-related associations between PCSK9 plasma levels and biochemical and anthropomorphic factors, and familial and personal morbidities, in a large European cohort (n = 3673) of men (47.9%) and women (52.1%). Methods: Individuals (aged 54-79 years) free of CV diseases were enrolled in seven centers of five European countries: Finland, France, Italy, the Netherlands, and Sweden. PCSK9 plasma levels were measured by ELISA. Results: PCSK9 was higher in women than in men. Multiple linear regression analysis showed that latitude, sex, and treatments with statins and fibrates were the strongest predictors of PCSK9 in the whole group. These variables, together with triglycerides and high-density lipoprotein cholesterol, were also associated with PCSK9 in men or women. Mean corpuscular hemoglobin concentration and pack-years were PCSK9 independent predictors in women, whereas hypercholesterolemia and physical activity were independent predictors in men. The associations between PCSK9 and latitude, uric acid, diabetes, hypercholesterolemia and physical activity were

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Section: Discussionmentioning

confidence: 99%

Sex-specific predictors of PCSK9 levels in a European population: The IMPROVE study

et al. 2020

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“…A number of potential mechanisms have been suggested, such as induction of vascular angiogenesis, metabolic adaptations within skeletal muscle, improved endothelial flow-mediated dilatation, reduced inflammatory activation, reduced endothelial and mitochondrial dysfunction, improved walking e iciency, and increased pain tolerance (Conte 2015;Haas 2012;Harwood 2016). Additionally, supervised exercise therapy potentially reduces cardiovascular risk (Jansen 2019).…”

Section: How the Intervention Might Workmentioning

confidence: 99%

Modes of exercise training for intermittent claudication

Jansen

Abaraogu

Lauret

et al. 2020

Cochrane Database of Systematic Reviews

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“…Indeed, the benefit of exercise therapy is even greater when supervised by trained personnel 35 . Further, cardiac rehabilitation promotes other secondary prevention modifications such as tobacco cessation 36 . Given the high prevalence of PAD in Korea, the high degree of health-related behaviour and the degree of impact where they are modified, achieving greater cardiac rehabilitation use has the potential to significantly reduce morbidity and associated health care costs.…”

Section: Discussionmentioning

confidence: 99%

Effect of physical inactivity and tobacco use on mortality and morbidity in revascularized patients with peripheral arterial disease: A nationwide cohort study

Cha

Grace

Han

et al. 2021

Preprint

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Importance: Physical activity (PA) and tobacco use are key health behaviours in patients with peripheral arterial disease (PAD). Limited studies are available on effects of those behaviours in PAD after revascularization, including Asian countries where tobacco use is high. Objective: To investigate the effects of PA and tobacco use on adverse clinical outcomes in patients with PAD after revascularization. Design: Retrospective cohort study Setting: Population–based study using the Korean National Health Insurance Service (NHIS) database Participants: Patients who had received revascularization for PAD between 2010–2015 were included. They were categorized as active or inactive based on the number of days per week they engaged in PA and as current or non–tobacco users (self–report). Exposures: PA and tobacco use. Main outcomes: The primary outcome was all–cause mortality. Secondary outcomes included major adverse outcome (a composite of all–cause mortality, myocardial infarction, and stroke) and major adverse limb event (MALE, a composite of amputation and recurrent revascularization). Results: The cohort comprised 8324 patients (mean age, 64.7 years; 76.9% male). Among them, 32.7% were inactive and 26.4% were tobacco users. Active patients had significantly better outcomes than inactive patients [all–cause mortality adjusted hazard ratio (adjHR) = 0.766 (0.685 – 0.855), major adverse outcome adjHR = 0.795 (0.719 – 0.878), MALE adjHR = 0.858 (0.773 – 0.953)]. Tobacco users had significantly poorer outcomes than non-users [all-cause mortality adjHR = 1.279 (1.124 – 1.456), major adverse outcome adjHR = 1.263 (1.124 – 1.418), MALE adjHR = 1.291 (1.143 – 1.458)]. Conclusions and Relevance: Even after receiving revascularization for PAD, a sizable proportion of patients were inactive and used tobacco, leading to adverse clinical outcomes. These modifiable risk factors are systematically addressed in cardiac rehabilitation; in line with current guideline recommendations, more needs to be done to ensure cardiac rehabilitation participation in patients with PAD.

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Beneficial Effects of Supervised Exercise Therapy on Modifiable Cardiovascular Risk Factors in Intermittent Claudication: A Systematic Review and Meta-analysis

Cited by 4 publications

References 0 publications

Sex-specific predictors of PCSK9 levels in a European population: The IMPROVE study

Sex-specific predictors of PCSK9 levels in a European population: The IMPROVE study

Modes of exercise training for intermittent claudication

Effect of physical inactivity and tobacco use on mortality and morbidity in revascularized patients with peripheral arterial disease: A nationwide cohort study

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