Background: Inflammation plays an important role in the initiation and progression of atherosclerosis and the development of atherosclerotic events. Elevated inflammatory markers, such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count are considered a risk marker for coronary artery disease (CAD) incidence or mortality. Placental growth factor (PlGF) contributes to atherogenesis through vascular inflammation and plaque destabilization.Therefore, correction of inflammation has become a goal of therapy.
Purpose: To evaluate the influence of exercise training on CRP, ESR, WBC count, PIGF levels and exercise tolerance (MET) in patients with CAD.
Methods: A total of 54 subjects were enrolled in the study: 34 patients (pts) with CAD (59.2 ± 8.2 years, 26 men) who were admitted to cardiac rehabilitation after myocardial infarction (CAD group) and 20 healthy controls (54.2 ± 8.0 years, 13 men; C group). At baseline in all pts and healthy controls values of CRP, ESR, WBC count and PIGF were determined and exercise test was performed. After the initial study, CAD group underwent a supervised 3 weeks aerobic exercise training at residential center and after that period values of CRP,ESR, WBC count, PIGF and exercise tolerance were determined again.
Results: Baseline value of CRP, ESR and WBC count was higher (P=0.038; P=0.019 and ns), as well as value of PIGF (8.8±4.4 vs 4.3 ±4.0 pg/ml, P=0.002), while exercise capacity was lower (5.7±2.1 vs 7.8 ±2.3 METs, P<0.01) in CAD group than in C group. After 3 weeks of exercise training in CAD group CRP decreased significantly (from 8.3±3.2 to 6.6±1.7 µmol/L, P=0.048), ESR (from 11.9±8.1 to 10.3±7.3 mm/1 hour , P<0.001) WBC count (from 8.2±2.0 to 7.6±1.8 109/L, P=0.002) and PIGF (from 8.8±4.4 to 5.3 ±3.5 pg/ml, P<0.001), while exercise capacity increased (P<0.001). At the end of the study difference in CRP, ESR, WBC count, PIGF and exercise tolerance between CAD and C group was less pronounced compare to the baseline (ns for all). A positive correlation was found between CRP and PIGF decrease (r=0.988, p<0.001), CRP and WBC decrease (r=0.816, p=0.002) and CRP decrease and METs increase during rehabilitation period (r=0.834, p<0.001). Also, there was a positive correlation between WBC and PIGF decrease (r=0.768, p<0.001), WBC decrease and METs increase (r=0.548, p=0.012) and PIGF decrease and METs increase (r=0.545, p=0.013). Conclusions: Residential exercise training in patients with CAD reduces inflammation, expressed through significant decrease of CRP, ESR, WBC count, and PIGF levels. Those positive changes in markers of inflammation were associated with significant improvement in exercise capacity.