Vascular Function and Structure in Veteran Athletes After MI

Study Questions:

Does the lifelong exercise training of post-myocardial infarction (MI) veteran athletes impart a superior peripheral vascular function and structure compared with post-MI sedentary peers?

Methods:

Seventy-five middle-aged men were sorted into the following four test groups: healthy, asymptomatic veteran athletes (ATH), their sedentary controls (SED), post-MI veteran athletes (ATH + MI), and post-MI sedentary controls (SED + MI). Veteran athletes had histories of lifelong (>20 years), regular, weekly, moderate (3-5.9 MET) to vigorous (6 MET) physical activity. All participants visited the laboratory on 2 separate days: day 1 included screening, physical exam, and incremental maximal cycling testing, and day 2 included blood samples for cardiovascular risk markers (glucose, lipids, and glycated hemoglobin) and thorough assessments of vascular structure and function by noninvasive echo-Doppler ultrasound techniques. Using the brachial artery, these techniques included endothelium-dependent flow mediated dilation (index of endothelial function), conduit artery vasodilatory capacity (index of arterial structure), and endothelium-independent dilation using glyceryl trinitrate (index of vascular smooth muscle function). Using the left carotid, right common femoral, and radial arteries, these techniques included measurements of pulse wave velocity (index of vascular stiffness) and conduit artery intima-media thickness.

Results:

As expected, veteran athletes (ATH and ATH + MI) had higher fitness levels (VO2 peak) and better cardiovascular risk profiles than sedentary peers, though no difference was found in age, height, mean arterial pressure, glycated hemoglobin, or family history of cardiovascular disease. The ATH group had better vascular function (i.e., endothelial function by flow-mediated dilation, pulse wave velocity) and structure (i.e., femoral intima-media thickness and wall-lumen ratio) than the SED group; however, no difference was found in indices of vascular function and structure in the ATH + MI group versus the SED + MI group. There was no difference between the MI groups in the extent and location of MI or treatment strategy. However, none of the ATH + MI group experienced a recurrent MI or need for elective percutaneous coronary intervention whereas two members of the SED + MI group reported recurrent MI, and six required elective percutaneous coronary intervention.

Conclusions:

This study demonstrated that the ATH group had better vascular structure and function than the SED group. However, the ATH + MI group did not have superior vascular structure and function than the SED + MI group. Lifelong exercise did impart benefits to the ATH + MI group compared with the SED + MI group in lower incidence of secondary events and improved cardiovascular risk profiles.

Perspective:

Regular exercise training reduces morbidity and mortality by improving cardiovascular risk factors and enhancing vascular function. In this study of post-MI volunteers, the veteran athletes had improved risk factor profiles and fewer secondary cardiac events, but veteran athletes did not demonstrate vascular structure and function superior to their sedentary peers. Further research is needed to explain the cardioprotective benefits of lifelong exercise, particularly after MI.

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Sports and Exercise Cardiology, Interventions and Coronary Artery Disease, Interventions and Imaging, Echocardiography/Ultrasound, Exercise, Sports & Exercise and Imaging

Keywords: Coronary Artery Disease, Risk Factors, Radial Artery, Brachial Artery, Hemoglobin A, Glycosylated, Pulse Wave Analysis, Vascular Stiffness, Athletes, Sports, Muscle, Smooth, Vascular, Arterial Pressure, Carotid Intima-Media Thickness, Myocardial Infarction, Percutaneous Coronary Intervention, Exercise


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