Fibro‐inflammatory recovery and type 2 diabetes remission following a low calorie diet but not exercise training: A secondary analysis of the DIASTOLIC randomised controlled trial (original) (raw)
Related papers
Nutrition, Metabolism and Cardiovascular Diseases, 2006
Background and aims: Some plasma biomarkers of inflammation and endothelial dysfunction have been recently recognized as important cardiovascular risk factors. Currently, there is little information about the effects of aerobic exercise training on these biomarkers in older adults with type 2 diabetes. We have therefore assessed the effects of a twice-weekly moderate, aerobic exercise programme, without a concomitant weight loss diet, on plasma inflammatory and endothelial dysfunction biomarkers in older type 2 diabetic patients. Methods and results: A group of 16 sedentary, overweight, non-smoking, older patients with type 2 diabetes volunteered to participate in a 6-month, supervised, progressive, aerobic training study, two times per week. Plasma levels of hs-Creactive protein (hs-CRP), soluble tumour necrosis factor (TNF)-a receptors, P-selectin and intercellular adhesion molecule-1 (ICAM-1) were measured before and after physical training. While hs-CRP and soluble TNF-a receptors remained essentially unaffected by physical training, plasma concentrations of P-selectin (P ! 0.001) and ICAM-1 (P ! 0.01) markedly decreased; physical training also increased HDL cholesterol by 12% (P ! 0.05) and decreased uric acid levels by w33% (P Z 0.021). Body weight, waist circumference, blood pressure, haemoglobin A1c, plasma triglyceride and LDL cholesterol concentrations did not change.
Exercise intervention and inflammatory markers in coronary artery disease: A meta-analysis
American heart journal, 2012
Background Inflammatory activity plays a role in the development and progression of coronary artery disease (CAD), and exercise confers survival benefit. We performed a meta-analysis of changes in inflammatory biomarkers over the course of exercise interventions in patients with CAD. Methods We searched MEDLINE, Embase, the Cochrane Collaboration, AMED, and CINAHL for studies reporting peripheral inflammatory biomarker concentrations before and after exercise interventions of ≥2 weeks in patients with CAD. Data were summarized using standard mean differences (SMD) and 95% CIs. Results Twenty-three studies were included. Concentrations of C-reactive protein (CRP; SMD −0.345, 95% CI −0.444 to −0.246, n = 1,466, P < .001), interleukin 6 (SMD −0.546, 95% CI −0.739 to −0.353, n = 280, P < .001), fibrinogen (SMD −0.638, 95% CI −0.953 to −0.323, n = 247, P < .001), and vascular cell adhesion molecule 1 (SMD −0.413, 95% CI −0.778 to −0.048, n = 187, P = .027) were lower postintervention. Higher total cholesterol (B = −0.328, 95% CI −0.612 to −0.043, P = .026) and higher total/high-density lipoprotein cholesterol ratios (B = −0.250, 95% CI −0.425 to −0.076, P = .008) at baseline were associated with greater reductions in CRP. In controlled studies, follow-up concentrations of CRP (SMD −0.500, 95% CI −0.844 to −0.157, nexercise/control = 485/284, P = .004), and fibrinogen (SMD −0.544, 95% CI −1.058 to −0.030, nexercise/control = 148/100, P = .038) were lower in subjects who exercised compared with controls. Conclusion Exercise training is associated with reduced inflammatory activity in patients with CAD. C-reactive protein and fibrinogen have provided the strongest evidence. Higher baseline CRP and adverse baseline lipid profiles predicted greater reductions in CRP.
Cardiovascular organ damage in type 2 diabetes mellitus: the role of lipids and inflammation
Cardiovascular Diabetology, 2019
Background: The relationship between dyslipidemia, inflammation and CV organ damage in type 2 diabetes mellitus (T2DM) is complex. Insulin resistance and inflammatory cytokines interleukins (ILs) increase plasma triglycerides (TG). ILs also up-regulate expression of matrix-metalloproteinases (MMPs) that, together with TG, decrease high density lipoprotein cholesterol (HDL) levels. High TG, low HDL, increased ILs and MMPs trigger structural and functional changes in different parts of cardiovascular (CV) system. To understand better the role of lipids and inflammation in CV organ damage, the present study investigated the interrelationships between lipids, ILs and MMPs, as well as the associations of lipids, ILs and MMPs with various CV measures, both in diabetic and non-diabetic population (nonT2DM). Methods: In T2DM patients (N = 191) and nonT2DM subjects (N = 94) were assessed carotid intima-media thickness (cIMT) and inter-adventitial diameter (IADiam), carotid wave speed (ccaWS), carotid-femoral pulse wave velocity (cfPWV), left ventricular (LV) mass, LV systolic (s′) and early diastolic (e′) longitudinal velocities of mitral annulus, together with glycemic control, lipid profile, IL-6, IL-18 and MMP-12. Results: T2DM patients, as compared to nonT2DM subjects, had significantly higher plasma levels of IL-6, IL-18, MMP-12 and lower HDL (P < 0.05-0.0001). They had also higher cIMT, IADiam, ccaWS, cfPWV and LV mass, and lower e′ velocity (P < 0.005-0.0001). Both in T2DM patients and nonT2DM subjects, MMP-12 increased with IL-6 (r = 0.43 and 0.39; P < 0.0001) and IL-18 (r = 0.32 and 0.42; P < 0.0001), and HDL decreased with MMP-12 (r = − 0.29 and − 0.42; P < 0.0001). In both populations, MMP-12 was directly associated with IADiam, ccaWS, cfPWV and LV mass (r = 0.42, 0.32, 0.26 and 0.29; P < 0.0001 in T2DM patients, and r = 0.39, 0.28, 0.32 and 0.27; P < 0.01-0.0001 in nonT2DM subjects). In multivariate analysis, MMP-12 remained independently related to IADiam, ccaWS, cfPWV and LV mass in T2DM patients, and to IADiam only in nonT2DM subjects. Conclusions: This cross-sectional study demonstrated a direct association between ILs and MMP-12, as well as an inverse association between MMP-12 and HDL, both in T2DM patients and in nonT2DM subjects. In T2DM patients, who had higher levels of ILs and MMP-12, the latter was independently related to several structural and functional markers of preclinical CV organ damage.
2009
Patients with T2DM mellitus have a high risk of developing CVD with a diminished survival rate compared with nondiabetes patients, making the prevention of CVD in patients with T2DM essential. The identification of patients who are at particular risk for future CVD events represents a strategy towards targeted prevention. Screening by means of blood-borne biomarkers that are associated with CVD, such as CRP adhesion molecules (VCAM-1 and ICAM-1) and vWf, may serve this purpose. Increased blood concentrations of the soluble forms of the adhesion molecules and the other biomarkers have been associated with CVD and have also been reported to be increased in T2DM, 1 although the results vary according to the specific marker investigated. Exercise training improves insulin sensitivity and prevents CVD, but the effect of physical training on forearm endothelial function, 2,3 and on CVD biomarkers in patients with obesity and/or T2DM has yielded conflicting results. 4,5 We have now determined whether an eight week homebased exercise training program would improve CVD biomarkers in patients with T2DM. Methods Twelve male patients with T2DM and nine male healthy control subjects participated in this study. The control subjects had normal glucose tolerance, which was determined by an OGTT. Two patients with T2DM were treated with diet alone, five patients were treated with metformin, and five patients were treated with metformin plus sulfonylurea as glucose lowering therapy. With the exception of medicallycontrolled hypertension (n=2; one patient was treated by an ACE inhibitor and one patient was treated by a beta blocker) and hypercholesterolemia (n=1; patient treated by statins) in T2DM patients, none of the subjects had any sign or history of overt CVD. In addition, three patients were prescribed statins plus ACE inhibitors by their general practitioner for preventative measures. Twenty-four hours before the experiment, all pharmacological treatment was suspended. One patient with T2DM and two healthy subjects in the control group were smokers. The two groups were matched for age, body weight and percentage of body fat. We also included an additional small group of subjects with IGT (n=4; as determined by an OGTT; 2 h plasma glucose concentration =10.1±1.6 mmol/L), who were
The anti-inflammatory effects of exercise training in patients with type 2 diabetes mellitus
European Journal of Cardiovascular Prevention & Rehabilitation, 2007
Physical exercise is the cornerstone of cardiovascular disease treatment. The present study investigated whether exercise training affects atherosclerotic plaque composition through the modification of inflammatoryrelated pathways in apolipoprotein E knockout (apoE -/-) mice with diabetic atherosclerosis. Forty-five male apoE -/mice were randomized into three equivalent (n=15) groups: control (CO), sedentary (SED), and exercise (EX). Diabetes was induced by streptozotocin administration. High-fat diet was administered to all groups for 12 weeks. Afterwards, CO mice were euthanatized, while the sedentary and exercise groups continued high-fat diet for 6 additional weeks. Exercising mice followed an exercise program on motorizedtreadmill (5 times/week, 60 min/session). Then, blood samples and atherosclerotic plaques in the aortic root were examined. A considerable (P<0.001) regression of the atherosclerotic lesions was observed in the exercise group (180.339±75.613¥10 3 μm 2 ) compared to the control (325.485±72.302¥10 3 μm 2 ) and sedentary (340.188±159.108¥10 3 μm 2 ) groups. We found decreased macrophages, matrix metalloproteinase-2 (MMP-2), MMP-3, MMP-8 and interleukin-6 (IL-6) concentrations (P<0.05) in the atherosclerotic plaques of the exercise group. Compared to both control and sedentary groups, exercise training significantly increased collagen (P<0.05), elastin (P<0.001), and tissue inhibitor of matrix metalloproteinase-2 (TIMP-2) (P<0.001) content in the atherosclerotic plaques. Those effects paralleled with increased fibrous cap thickness and less internal elastic lamina ruptures after exercise training (P<0.05), while body-weight and lipid parameters did not significantly change. Plasma MMP-2 and MMP-3 concentrations in atherosclerotic tissues followed a similar trend. From our study we can conclude that exercise training reduces and stabilizes atherosclerotic lesions in apoE -/mice with diabetic atherosclerosis. A favorable modification of the inflammatory regulators seems to explain those beneficial effects.
Nutrition, Metabolism and Cardiovascular Diseases, 2010
Background and aims: We investigated the effect of different exercise modalities on high sensitivity-C reactive protein (hs-CRP) and other inflammatory markers in patients with type 2 diabetes and the metabolic syndrome. Methods and results: Eighty-two patients were randomized into 4 groups: sedentary control (A); receiving counseling to perform low-intensity physical activity (B); performing prescribed and supervised high-intensity aerobic (C) or aerobic þ resistance (D) exercise (with the same caloric expenditure) for 12 months. Evaluation of leisure-time physical activity and assessment of physical fitness, cardiovascular risk factors and inflammatory biomarkers was performed at baseline and every 3 months. Volume of physical activity increased and HbA 1c decreased in Groups BeD. VO 2max , HOMA-IR index, HDL-cholesterol, waist circumference and albuminuria a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / n m c d Nutrition, Metabolism & Cardiovascular Diseases (2010) 20, 608e617
European Journal of Clinical Investigation
Background: No data on the prognostic impact of atrial fibrillation in angiographied coronary patients are available. Materials and methods: In a consecutive series of 622 patients (418 men and 204 women) who underwent coronary angiography for the evaluation of established or suspected coronary artery disease we evaluated electrocardiograms according to the Minnesota Code. Prospectively, all-cause mortality, cardiac death (including fatal myocardial infarction, sudden cardiac death, and death from congestive heart failure due to coronary artery disease) and major coronary events (including death due to coronary heart disease and non fatal myocardial infarction) were recorded over 4 years. Results: From our patients, 37 (5AE9%) at baseline had atrial fibrillation, 576 (92AE7%) exhibited sinus rhythm, and 4 (0AE6%) had persistent supraventricular rhythms, and 5 (0AE8%) pacemaker rhythms. Presence of atrial fibrillation was associated with a lower prevalence of significant coronary stenoses with narrowing of at least ‡50% at the baseline angiography [adjusted odds ratio = 0AE121 (95% CI 0AE051-0AE289), P < 0AE001). Prospectively, however, patients with atrial fibrillation were at a strongly increased risk of all-cause mortality [adjusted hazard ratio (HR) = 4AE529 (2AE070-9AE911), P < 0AE001], cardiac death [HR = 7AE239 (2AE569-20AE399), P < 0AE001], and major coronary events [HR = 4AE529 (2AE070-9AE911), P < 0AE001]. Conclusions: Atrial fibrillation is inversely associated with the presence of angiographically diagnosed coronary artery disease, but is a strong predictor of death and cardiac events in angiographied coronary patients.
American Journal of Cardiology, 2014
Higher levels of physical activity are associated with lower rates of coronary heart disease (CHD). Previous studies have suggested that this is due partly to lower levels of inflammation and insulin resistance. The aim of this study was to determine whether physical activity level was associated with inflammation or insulin resistance during a 5-year period in outpatients with known CHD. A total of 656 participants from the Heart and Soul Study, a prospective cohort study of outpatients with documented CHD, were evaluated. Self-reported physical activity frequency was assessed at baseline and after 5 years of follow-up. Participants were classified as low versus high activity at each visit, yielding 4 physical activity groups: stable low activity, decreasing activity (high at baseline to low at year 5), increasing activity (low at baseline to high at year 5), and stable high activity. Year 5 markers of inflammation (C-reactive protein [CRP], interleukin-6, and fibrinogen) and insulin resistance (insulin, glucose, and glycated hemoglobin) were compared across the 4 activity groups. After 5 years of follow-up, higher activity was associated with lower mean levels of all biomarkers. In the fully adjusted regression models, CRP, interleukin-6, and glucose remained independently associated with physical activity frequency (log CRP, p for trend across activity groups = 0.03; log interleukin-6, p for trend = 0.01; log glucose, p for trend = 0.003). Subjects with stable high activity typically had the lowest levels of biomarkers. In conclusion, in this novel population of outpatients with known CHD followed for 5 years, higher physical activity frequency was independently associated with lower levels of CRP, interleukin-6, and glucose.
Canadian Journal of Diabetes, 2020
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