Exercise and Coronary Atherosclerosis

     Studies investigating the relationship between physical activity/exercise and coronary atherosclerosis in the general population have revealed mixed results that show no clear net effect. However, studies in athletes have demonstrated a higher prevalence of coronary artery calcification score≥100 compared with less active controls. Increased coronary atherosclerosis in athletes may be mediated via several mechanisms. The clinical relevance of increased coronary atherosclerosis in athletes is unclear, but the absence of coronary artery calcification or plaque is better than the presence of any atherosclerosis. Higher coronary artery calcification score among athletes may not necessarily reflect an increased risk for cardiovascular events similar to the general population because exercise promotes beneficial coronary adaptations and increased calcification may be associated with plaque stabilization, which likely explains some of the significant reduction in cardiovascular events because of exercise training. Statin therapy and intensive risk factor management are recommended for athletes with coronary artery calcification, depending on their coronary artery calcification score and estimated 10-year atherosclerotic cardiovascular disease risk, to stabilize plaques and prevent coronary events. Future longitudinal studies are anticipated to further investigate the role of exercise in coronary atherosclerosis.

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Aengevaeren, V. L., Mosterd, A., Sharma, S., Prakken, N. H. J., Möhlenkamp, S., Thompson, P. D., . . . Eijsvogels, T. M. H. (2020). Exercise and Coronary Atherosclerosis. 141(16), 1338-1350. doi:doi:10.1161/CIRCULATIONAHA.119.044467

Effects of aerobic exercise on lipids and lipoproteins

     Dyslipidemia is the risk of cardiovascular disease, and their relationship is clear. Lowering serum cholesterol can reduce the risk of coronary heart disease. At present, the main treatment is taking medicine, however, drug treatment has its limitations. Exercise not only has a positive effect on individuals with dyslipidemia, but can also help improve lipids profile. Currently, clinicians may be excessively reliant on lipid-lowering drugs (i.e., statins) to treat patients with dyslipidemias. In our opinion, aggressive lifestyle alterations, such as exercise, should not be abandoned. Such knowledge should aid in preventing and treating dyslipidemia while reducing the risks of myocardial infarctions and coronary artery disease. Clinicians should encourage as much physical activity as possible.

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Wang Y, Xu D. Effects of aerobic exercise on lipids and lipoproteins. Lipids Health Dis. 2017 Jul 5;16(1):132. doi: 10.1186/s12944-017-0515-5. PMID: 28679436; PMCID: PMC5498979.

The effects of high-intensity interval training on reverse cholesterol transport elements: A way of cardiovascular protection against atherosclerosis

     Reverse cholesterol transport (RCT) is a process that prevents atherosclerosis. Studies showed that exercise training for strengthening cardiac muscle, increasing heart lipid metabolism and its potency against risk factors could protect cardiovascular health. High-intensity interval training (HIIT) result in cardiovascular protection by increasing the expression of genes involved in RCT and biogenesis of HDL.

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Saleh Rahmati-Ahmadabad, Hossein Shirvani, Abbass Ghanbari-Niaki, Fatemeh Rostamkhani, The effects of high-intensity interval training on reverse cholesterol transport elements: A way of cardiovascular protection against atherosclerosis, Life Sciences, Volume 209, 2018, Pages 377-382, ISSN 0024-3205, https://doi.org/10.1016/j.lfs.2018.08.036. (https://www.sciencedirect.com/science/article/pii/S0024320518304879).

High-intensity interval training has a greater effect on reverse cholesterol transport elements compared with moderate-intensity continuous training in obese male rats

    Reverse Cholesterol Transport (RCTr) is the mechanism by which excess cholesterol from peripheral tissues is transported to the liver for hepatobiliary excretion, thereby inhibiting foam cell formation and the development of atherosclerosis. Exercise affects RCTr, by influencing high-density lipoprotein cholesterol (HDL) through remodeling and by promoting hepatobiliary sterol excretion. High-intensity interval training (HIIT; 18 min) may have more cardioprotective effects than moderate-intensity continuous training (MIT; 1 h) against atherosclerosis, along with saving time, as supported by the changes observed in the main factors involved in the reverse cholesterol transport (RCT) process.

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Saleh Rahmati-Ahmadabad, Mohammad-Ali Azarbayjani, Parvin Farzanegi, Lida Moradi, High-intensity interval training has a greater effect on reverse cholesterol transport elements compared with moderate-intensity continuous training in obese male rats, European Journal of Preventive Cardiology, Volume 28, Issue 7, July 2021, Pages 692–701, https://doi.org/10.1177/2047487319887828.

Effects of exercise on reverse cholesterol transport

     Reverse Cholesterol Transport (RCTr) is the mechanism by which excess cholesterol from peripheral tissues is transported to the liver for hepatobiliary excretion, thereby inhibiting foam cell formation and the development of atherosclerosis. Exercise affects RCTr, by influencing high-density lipoprotein cholesterol (HDL) through remodeling and by promoting hepatobiliary sterol excretion. Moderate intensity and longer-term training has a greater effect on RCTr elements than low intensity training. There a few studies examining high intensity training which warrants further investigation.

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Saleh Rahmati-Ahmadabad, David Robert Broom, Abbass Ghanbari-Niaki, Hossein Shirvani, Effects of exercise on reverse cholesterol transport: A systemized narrative review of animal studies, Life Sciences, Volume 224, 2019, Pages 139-148, ISSN 0024-3205, https://doi.org/10.1016/j.lfs.2019.03.058. https://www.sciencedirect.com/science/article/pii/S0024320519302218.