Treatment of coronary heart disease by diet and exercise: Fasting and diurnal lipoproteins

Summary The effects of a combined exercise and low-fat dientary regimen were studied in 11 patients with angiographically documented coronary heart disease (cholesterol 233 mg/dl, triglycerides 158 mg/dl) and 13 comparable patients (cholesterol 224 mg/dl, triglycerides 174 mg/dl) on usual care. During one year, fasting serum lipoproteins were lowered to ideal levels in the intervention group (cholesterol 191 mg/dl, triglycerides 100 mg/dl, LDL-cholesterol 121 mg/dl). There was no change of triglycerides and cholesterol on usual care while LDL-cholesterol rose significantly. Neither regimen had any effect on HDL-cholesterol. Diurnal triglycerides as a presumptive measure of IDL in the intervention group were diminished by 39%. The study demonstrates the feasibility of a diet and exercise regimen to normalize midly elevated plasma lipid levels and thus to possibly affect the course of coronary heart disease without drugs.Abbreviations Chol cholesterol - TG triglycerides - HDL high density lipoproteins - LDL low density lipoproteins - LP(a) lipoprotein (a) - P/S polyunsaturated to saturated fatty acid ratio - Int. Intervention group - C Control group Supported by Bundesministerium für Forschung und Technologie     

Effects of inducing physiological hyperglucagonemia on metabolic responses to exercise

The purpose of the present study was to assess the effects of exogenously increasing the circulating levels of glucagon on the metabolic responses to exercise in rats. A total of six groups of rats were infused (iv) either with glucagon (20 or 50 ng·kg⁻¹·min⁻¹) or saline (0.9% NaCl), either in the resting state or during a bout of running exercise (45 min, 26 m·min⁻¹, 0% grade). Blood samples were taken at the end of the 45-min experiment. Animals infused with glucagon at 50 ng·kg⁻¹·min⁻¹ showed significantly (P<0.01) higher mean plasma glucagon concentrations than animals infused with saline or glucagon at 20 ng·kg⁻¹·min⁻¹. In addition, exercise resulted in significantly (P<0.05) higher mean plasma glucagon concentrations, compared to rest, in all groups. In spite of these differences in glucagon concentrations, there were no significant (P>0.05) effects of exercise and glucagon infusion on mean hepatic glycogen, plasma glucose, insulin, C-peptide, β-hydroxybutyrate, or catecholamine concentrations. Although exercise resulted in a significant (P<0.01) increase in plasma glycerol and free fatty acid concentrations and a significant (P<0.05) decrease in glycogen in the soleus muscle, these responses were not affected by the glucagon infusion. These results suggest that the liver is non-responsive to physiological hyperglucagonemia in a short-term (45 min) exercise situation. Electronic Publication     

Impact of exercise on blood lipids and lipoproteins

Abnormal blood lipids are a significant cardiovascular health risk. Drug therapy and diet continue to be standard management strategies. However, considerable evidence supports physical activity and exercise as having a positive impact on abnormal lipids and such are often recommended as adjunctive interventions. The purpose of this review is to clarify the mechanisms by which exercise facilitates favorable changes in levels of blood lipids and lipoproteins. Studies relative to the effects of exercise on blood lipid levels are notable: The impact of exercise on high-density lipoproteins (HDL-C) is best studied and specify effects of intensity and amount of exercise as well as a genetic influence. Exercise also exerts an effect on HDL-C maturation and composition, cholesterol efflux, and cholesterol delivery to receptors (reverse cholesterol transport). Positive effects of exercise are also seen with blood triglycerides (TG), but little specific effect is seen on low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC). Abundant evidence supports the benefits of exercise on levels of certain blood lipids (namely HDL-C and TG). Although standard management of abnormal blood lipids is drug therapy and diet, it seems prudent to incorporate aerobic exercise as an important component of a healthy lifestyle. In certain individuals, drug therapy may be decreased in dosage or perhaps discontinued in the patient who is "exercise trained," especially if there is associated weight loss.     

载脂蛋白E基因多态性与血脂代谢及冠心病的关系

目的：研究载脂蛋白E基因多态性对血脂代谢的影响及其与冠心病的关系。方法：运用PCR－PFLP方法检测168例江苏地区无血缘健康汉族人群。分析健康人群各基因型及等位基因对血脂、载脂蛋白及脂蛋白（a）的影响,同时测定63全冠心病患者载脂蛋白E基因型,并与性别相匹配的90例正常对照组比较各基因型及等位基因频率分布。结果：载脂蛋白E各基因型血清总胆固醇（TC）、低密度脂蛋白胆固醇（LDL－C）及载脂蛋白B（ApoB）水平由高到低依次为ε3／4＞ε3／3＞ε2／3;各等位基因TC、LDL－C及ApoB水平由高到低依次为ε4＞ε3＞ε2。ε2等位基因具有明显的降低TC、LDL－C和ApoB的作用,而ε4等位基因明显的升高TC、LDL－C和ApoB的作用。冠心病组ε4等位基因频率（12.70%）明显高于对照组（5.55%）。结论：载脂蛋白E基因多态性影响血脂及载旨蛋白水平。ε2 基因具有明显的降低TC、LDL－C和ApoB的作用,而ε4等位基因的作用正相反。ε4等位基因可能是冠心病的遗传易患因子。     

Metabolic consequences of repeated exercise in long distance runners

Summary To assess the rates of change in muscle metabolites such as phosphocreatine (PCr) and inorganic phosphate (P_i) during repeated exercise sessions with rest periods, 31-phosphorus nuclear magnetic resonance spectroscopy was used for continuous and noninvasive measurements. Five long-distance runners and six healthy male subjects as controls performed a 2-min femoral flexion exercise at 20 kg · m · min^–1 in a 2.1 T superconducting magnet with a 67-cm bore; they repeated this exercise four times with a 2-min rest period. At the beginning of exercise, PCr decreased exponentially; at the end, it increased. During exercise and in the early phase of the recovery in every exercise session, the PCr values were significantly higher in the long-distance runners than in the control subjects (P<0.05). The Pi increases and decreases involved with exercise also revealed exponential changes. The P_i values did not significantly differ during exercise; however, P_i recovery was faster in the long-distance runners than in the control subjects (P < 0.05). The P_i: PCr ratio during exercise increased linearly with exercise; and P_i:PCr during recovery was smaller in the long-distance runners than in the control subjects (P < 0.05). In conclusion, the long-distance runners revealed faster PCr and P_i kinetics after exercise and a smaller P_i:PCr during exercise than did the control subjects. It is suggested that these results were attributable to a greater oxidative capacity of muscles in the long-distance runners.     

福辛普利治疗对老年冠心病患者冠脉血流储备的影响

目的观察老年冠心病患者中冠状动脉血流储备(CFR)的变化及福辛普利治疗对老年冠心病患者CFR的影响.方法选取27例老年冠心病患者及28例健康老年人作对照组,将福辛普利(5～10 mg)治疗前患者的血压、血糖、血脂(serum total cholesterol,TC;low density lipid cholesterol,LDL-C;triglyceride,TG)、血清内皮素(ET-1)的浓度以及CFR(应用彩色多普勒超声仪检测)与对照组进行比较,并将治疗前后的各项指标进行比较.结果冠心病患者血压、血糖与TG水平与对照组比较没有显著性差异(P＞0.05),而TC及LDL-C水平明显高于对照组(P＜0.05及P＜0.01),福辛普利治疗前后患者的血压、血糖与血脂无明显改变(P＞0.05).冠心病组ET-1水平为(113.5±9.7)pg/ml较对照组(76.2±10.8)pg/ml高(P＜0.01),福辛普利治疗6月后,ET-1浓度下降为(77.5±12.0)pg/ml(P＜0.01).冠心病患者CFR低于对照组(P＜0.01),福辛普利治疗6月后,CFR上升(P＜0.01).结论福辛普利治疗可改善老年冠心病患者的内皮功能,并能明显改善患者的CFR.     

Age-related changes in subcutaneous adipose tissue of adolescent distance runners and association with blood lipoproteins

PRIMARY OBJECTIVE: The purpose of this study was to examine age- and sex-associated variation in subcutaneous adipose tissue (SAT) and its association with blood lipoproteins among adolescent distance runners. METHODS: Serial data included 99 annual measurements for 27 males and 84 annual measurements for 27 females, aged 9-18 years. SAT was expressed as the sum of six skinfolds (SUM6; subscapular, supra-iliac, abdominal, triceps, biceps and medial calf). The ratio of the sum of three trunk skinfolds to the sum of three extremity skinfolds (TER) was used an index of relative subcutaneous fat distribution. Total blood cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) were determined by standard procedures. RESULTS: Age- and sex-associated variation in SAT of adolescents engaged in regular endurance training is similar to trends observed in the general population of youths, although SUM6 is less. An increase in SUM6, rather than the TER, is significantly associated with an increase in LDL-C, TG and TC:HDL in adolescent males, and a decline in HDL-C and an increase in TG in females. CONCLUSIONS: This study demonstrates the differential effects of gender on the pubertal development of SAT and blood lipoproteins in young distance runners and highlights the need to explore the interactions among sexual maturation, fatness, fat distribution, exercise training, and blood lipoproteins during adolescence.     

Age-related changes in subcutaneous adipose tissue of adolescent distance runners and association with blood lipoproteins

Primary objective : The purpose of this study was to examine age- and sex-associated variation in subcutaneous adipose tissue (SAT) and its association with blood lipoproteins among adolescent distance runners. Methods : Serial data included 99 annual measurements for 27 males and 84 annual measurements for 27 females, aged 9-18 years. SAT was expressed as the sum of six skinfolds (SUM6; subscapular, supra-iliac, abdominal, triceps, biceps and medial calf). The ratio of the sum of three trunk skinfolds to the sum of three extremity skinfolds (TER) was used an index of relative subcutaneous fat distribution. Total blood cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) were determined by standard procedures. Results : Age- and sex-associated variation in SAT of adolescents engaged in regular endurance training is similar to trends observed in the general population of youths, although SUM6 is less. An increase in SUM6, rather than the TER, is significantly associated with an increase in LDL-C, TG and TC:HDL in adolescent males, and a decline in HDL-C and an increase in TG in females. Conclusions : This study demonstrates the differential effects of gender on the pubertal development of SAT and blood lipoproteins in young distance runners and highlights the need to explore the interactions among sexual maturation, fatness, fat distribution, exercise training, and blood lipoproteins during adolescence.     

The effects of a transtheoretical model-based exercise stage-matched intervention on exercise behavior in patients with coronary heart disease: A randomized controlled trial

Objective

To determine whether a transtheoretical model-based exercise stage-matched intervention (ESMI) has positive effects on the exercise behavior of sedentary patients with coronary heart disease (CHD).

Methods

The study was a randomized controlled trial with a repeated measures design. Participants (N = 196) were randomly allocated to either a conventional (C) group, a patient education (PE) group, or an ESMI group. Exercise behavior was measured by exercise stages of change, exercise self-efficacy, exercise decisional balance, and duration of moderate exercise at baseline, immediate post-intervention, and at 3- and 6-month follow-up.

Results

Our results showed that the ESMI group demonstrated a more positive shift in exercise stages of change (p < 0.01), higher exercise self-efficacy (p < 0.01), greater exercise benefits (p < 0.01), fewer exercise barriers (p < 0.01), and longer moderate exercise duration (minutes/week) (p < 0.01) after completion of the 8-week intervention compared with the C and PE groups. These significantly positive effects were maintained at 3- and 6-month follow-up.

Conclusion

The transtheoretical model-based ESMI had significantly positive effects on the exercise behavior of sedentary CHD patients.

Practice implications

It is important to provide a structured education program for CHD patients, preferably guided by the transtheoretical model.     

Interactive voice response telephony to promote smoking cessation in patients with heart disease: a pilot study

OBJECTIVE: A pilot study was conducted to determine the feasibility and potential efficacy of an interactive voice response (IVR) follow-up system for smokers recently hospitalized with coronary heart disease (CHD). METHODS: Ninety-nine smokers hospitalized with CHD completed a baseline questionnaire, were provided with bedside counseling, and offered nicotine replacement therapy. They were randomly assigned to a usual care (UC) or an IVR group. The IVR group received automated telephone follow-up calls 3, 14 and 30 days after discharge inquiring about their smoking status and confidence in remaining smoke-free. When deemed necessary, they were offered additional counseling. Smoking status was determined 52 weeks after hospital discharge. RESULTS: The 52-week point prevalence abstinence rate in the IVR group was 46.0% compared to 34.7% in the UC group (OR=1.60, 95% CI: 0.71-3.60; P=.25). After adjustment for education, age, reason for hospitalization, length of hospitalization, and quit attempts in the past year, the odds of quitting in the IVR group compared to the UC group were 2.34 (95% CI: 0.92-5.92; P=.07). CONCLUSIONS: IVR is a promising technology for following CHD patients attempting to quit smoking following discharge from hospital, however, a larger trial is required to confirm its efficacy. PRACTICE IMPLICATIONS: IVR may enhance the timely provision of follow-up counseling for smoking cessation in patients with CHD.     

藻酸双酯钠对老年冠心病患者血脂及血液流变性的影响

目的探讨藻酸双酯钠对老年冠心病患者血脂及血液流变性的影响.方法132例伴高脂血症及高黏血症的老年冠心病患者随机分为治疗组及对照组,治疗组在基础治疗上加用藻酸双酯钠100mg静滴,每日1次,2周为1疗程,对照组除不用藻酸双酯纳外,其他治疗与治疗组相同,治疗前后检测血脂及血液流变性各项指标.结果藻酸双酯钠治疗组血脂及血液流变性各项指标有显著改善(P＜0.01),而对照组仅全血黏度有所改善(P＜0.05),其它各项指标无显著性变化(P＞0.05).结论藻酸双酯钠是一种调节血脂代谢紊乱和改善血液高黏度的理想药物,对防治冠心病非常有益.     

Glucose tolerance,plasma lipoproteins and tissue lipoprotein lipase activities in body builders

Summary Oral glucose tolerance, insulin binding to erythrocyte receptors, serum lipids, and lipoproteins, and lipoprotein lipase activities of adipose tissue and skeletal muscle were measured in nine body builders (relative body weight (RBW) 118±4%), eight weight-matched (RBW 120±5%) and seven normal-weight controls (RBW 111±3%). The body builders had 50% higher relative muscle mass of body weight (% muscle) and 50% smaller relative body fat content (% fat) than the two other groups (P<0.005). Maximal aerobic power was comparable in the three groups. In the oral glucose tolerance test (OGTT), blood glucose levels, and plasma insulin levels were lower (P<0.05) in the body builders than in weight-matched controls. Insulin binding to erythrocytes was similar in each group. On the basis of multiple linear regression analysis, 87% of the variation in plasma insulin response could be explained by body composition (% muscle and % fat) and .Plasma total cholesterol, low-density lipoprotein (LDL) cholesterol, and very low-density lipoprotein (VLDL) triglyceride concentrations were significantly lower in the body builders than in weight-matched controls. In comparison with the normal-weight group, the body builders had a lower total cholesterol level. High density lipoprotein (HDL) cholesterol, its subfractions (HDL₂ and HDL₃ cholesterol) and lipoprotein lipase (LPL) activities of adipose tissue and skeletal muscle were comparable in all three groups. Partial correlation analysis showed a positive relationship between plasma total triglyceride, total cholesterol and LDL cholesterol on the other hand and the % fat on the other.The results indicate that a shift in body composition from the adipose to the muscular type is associated with 1) lower glucose and insulin levels during the OGTT and 2) decrease in total and VLDL triglyceride and in total and LDL cholesterol levels but unchanged HDL cholesterol level. Thus, body builders are characterized by some metabolic features which decrease the risk of coronary heart disease. In contrast to aerobic training, body building does not influence HDL or its subfractions.     

Human muscle fiber types in power lifters,distance runners and untrained subjects

Summary Muscle biopsies were taken from the vastus lateralis of 12 males: 5 control subjects, 4 power lifters and 3 distance runners. Three fiber types were distinguished by comparing serial sections for alkaline myofibrillar adenosine triphosphatase (ATPase) and succinic dehydrogenase (SDH) activities: 1. high ATPase and low SDH; fast-twitch-glycolytic (FG). 2. High ATPase and high SDH; fast-twitch-oxidative-glycolytic (FOG). 3. Low ATPase and high SDH; slow-twitch-oxidative (SO). In some cases the distinction between the FOG and FG classes was not clear and a group termed transitional was employed. A variation in percentage of fiber types and fiber area was found among individuals. The percentage of SO fibers varied from 19.6–60.1% within all 3 groups, with a mean of 40.5%. In the control group approximately 75% of the fibers were oxidative (FOG+SO). The major characteristics of the lifters were a decrease in the percentage of FOG fibers and a hypertrophy of FOG and FG fibers. The distance runners had a high percentage of oxidative fibers with few FG fibers. It is suggested that the fast-twitch fibers are mainly involved in the adaptation of muscle to exercise since the percentage of SO fibers varies greatly among individuals within and between the 3 groups studied.     

心理干预对冠心病患者生活质量的影响

目的探讨心理干预对冠心病患者生活质量的影响。方法将住院的120例冠心病患者随机的等分为对照组和干预组(各60例),对照组仅采用常规临床药物治疗,干预组在进行常规临床药物治疗的同时实施心理干预,运用西雅图心绞痛调查量表分别于干预前及干预后对两组患者进行评定。结果干预前,干预组和对照组SAQ各因子之间没有差异(P0.05)。干预后,对干预组和对照组SAQ各因子前后测差值进行比较,干预组心绞痛发作情况、治疗满意程度、疾病认识程度以及西雅图总分差值明显高于对照组(t=4.015,8.774,6.771,9.972;P0.01)。结论心理干预能够有效改善冠心病患者的生活质量。     

心理干预对冠心病患者自测健康的影响

目的探讨心理干预对冠心病患者自测健康的影响。方法将120例住院冠心病患者随机等分为干预组和对照组,对照组只给予心内科常规治疗,干预组在给予心内科常规治疗的基础上进行心理干预,使用自测健康量表(SRHMS)分别于心理干预前后对两组患者进行评定。结果对干预组和对照组再次使用自测健康量表(SRHMS)进行评定,干预组在自测健康的3个维度(生理健康上t=2.772,P0.01,心理健康上t=7.779,P0.001,社会健康上t=6.403,P0.001)和总体心理健康得分上(t=7.035,P0.001)差值都显著高于对照组。结论在心内科常规治疗的基础上,对冠心病患者进行综合心理干预,能够有效改善患者的健康水平。     

非糖尿病患者糖化血红蛋白和胰岛素抵抗与 冠状动脉病变程度的相关性研究

目的 研究非糖尿病的冠心病患者中糖化血红蛋白（HbA1c）和胰岛素抵抗与冠状动脉病变严重程度的关系。方法 纳入临床疑诊冠心病并接受冠状动脉造影的非糖尿病患者184例,依据SYNTAX积分分为轻度狭窄组（0~22分）60例、中度狭窄组（23~32分）76例、重度狭窄组（≥33分）48例,采用Pearson相关性分析及多元线性逐步回归分析SYNTAX积分与HbA1c水平、稳态模型胰岛素抵抗指数（HOMA-IR）的关系。结果 三组间年龄、吸烟史、TC、LDL-C、HbA1c、HOMA-IR及CRP水平差异有统计学意义（P＜0.05）。相关性分析显示SYNTAX积分与HbA1c、HOMA-IR及CRP水平呈正相关,HbA1c与HOMA-IR呈正相关,多元线性逐步回归分析显示年龄、吸烟、HbA1c、HOMA-IR及CRP与冠脉病变程度独立相关。结论 在非糖尿病的冠心病人群中存在胰岛素抵抗,且胰岛素抵抗、HbA1c水平与冠状动脉病变严重程度密切相关。     

Effects of mechanical properties of muscle and tendon on performance in long distance runners

The purpose of this study was to investigate the mechanical properties of muscle and tendon in long distance runners and their relations to running performance. Fifteen long distance runners (LDR) and 21 untrained subjects (CON) participated in this study. Muscle strength and activation level of knee extensors and plantar flexors were measured. Tendon elongation was determined using ultrasonography, while subjects performed ramp isometric knee extension and plantar flexion up to the voluntary maximum. Relative MVC (to body mass) of LDR was significantly lower than that of CON for knee extensors, but not for plantar flexors. No significant difference in the neural activation levels was found between LDR and CON for both sites. Maximal tendon elongation of LDR was significantly lower than that of CON for knee extensors, but not for plantar flexors. Furthermore, faster running time in a 5,000 m race (best official record of LDR) was associated with lower tendon stiffness for both sites. In conclusion, the tendon of long distance runners is less extensible than those of untrained subjects for knee extensors, but not for plantar flexors. For both sites, however, the lower tendon stiffness may be in favor of the running performance in long distance runners.     

Effects on lipids and lipoproteins in women treated with oestradiol and progesterone

Thirty women with climacteric symptoms were treated for 4 months with 2 mg 17β-oestradiol and different doses of progesterone (50, 100 or 200 mg). The concentrations of total and free cholesterol, phospholipids, triglycerides (TG), apoprotein A1 and apoprotein B were determined in high-density lipoprotein (HDL), low-density lipoprotein (LDL) and very-low-density lipoprotein (VLDL) fractions and in serum. HDL levels increased and LDL levels decreased, while TG levels in VLDL remained unchanged, which indicates that the lipoprotein pattern is oestrogen-induced and that progesterone exerts little or no influence.