Long-term Exercise and Atherogenic Activity of Blood Mononuclear Cells in Persons at Risk of Developing Ischemic Heart Disease

• Published in: JAMA : the journal of the American Medical Association 1999-05, Vol.281 (18), p.1722-1727
• Main Authors: Smith, J. Kelly, Dykes, Rhesa, Douglas, John E, Krishnaswamy, Guha, Berk, Steven
• Format: Article
• Language: English
• Subjects: Arteriosclerosis - immunology; Biological and medical sciences; C-Reactive Protein - analysis; Cardiology. Vascular system; Cardiovascular disease; Coronary heart disease; Cytokines; Cytokines - biosynthesis; Cytokines - blood; Exercise; Exercise - physiology; Female; Health risk assessment; Heart; Humans; Immunophenotyping; Leukocytes, Mononuclear - immunology; Lymphocyte Activation; Male; Medical research; Medical sciences; Middle Aged; Myocardial Ischemia - immunology; Risk
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.281.18.1722

CONTEXT Increasing evidence demonstrates that atherosclerosis is an immunologically mediated disease in which the secretion of atherogenic and atheroprotective cytokines, by infiltrating blood mononuclear cells, plays an important role. It is not known whether long-term exercise alters this atherogenic and atheroprotective activity directly. OBJECTIVE To determine the effect of long-term exercise on the atherogenic activity of blood mononuclear cells in persons at risk of developing ischemic heart disease. DESIGN Before-after trial using a 6-month individualized, supervised exercise program, with an enrollment period from December 1996 to October 1997. SETTING Hospital-based community wellness center. PARTICIPANTS Of 110 persons who responded to a public request for volunteers, 52 met the inclusion criteria (risk ratio for myocardial infarction ≥1.7 based on serum complement and/or C-reactive protein levels, and normal exercise treadmill test results). Forty-three of the 52 enrollees (25 women [mean age, 49.7 years] and 18 men [mean age, 48.1 years]) completed the study; 9 withdrew for personal reasons. Additional risk factors for ischemic heart disease included hypercholesterolemia (65.1%), a family history of coronary heart disease (62.8%), inactivity (60.5%), hypertension (32.6%), obesity (25.6%), smoking (11.6%), and diabetes mellitus (4.7%). MAIN OUTCOME MEASURES Blood levels were compared at baseline and after the exercise program had been completed for the following: spontaneous and phytohemagglutinin-induced production of interleukin 1 α, tumor necrosis factor α, and interferon gamma (atherogenic cytokines), and interleukin 4, interleukin 10, and transforming growth factor beta 1 (atheroprotective cytokines) by blood mononuclear cells; lymphocyte phenotypes and mitogenic responses to phytohemagglutinin; and serum C-reactive protein levels. RESULTS Subjects exercised for a mean of 2.5 (range, 0.3-7.4) hours per week. Mononuclear cell production of atherogenic cytokines fell by 58.3% (P