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Original Research |

The Effect of Weight Loss and Exercise Training on Flow-Mediated Dilatation in Coronary Heart DiseaseWeight Loss Improves Flow-Mediated Dilatation: A Randomized Trial

Philip A. Ades, MD; Patrick D. Savage, MS; Stefan Lischke, MD; Michael J. Toth, PhD; Jean Harvey-Berino, PhD; Janice Y. Bunn, PhD; Maryann Ludlow, RD; David J. Schneider, MD
Author and Funding Information

From the Department of Medicine (Drs Ades, Lischke, Toth, and Schneider and Mr Savage), the Department of Nutrition (Dr Harvey-Berino and Ms Ludlow), and the Department of Biostatistics (Dr Bunn), Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont College of Medicine, South Burlington, VT.

Correspondence to: Philip A. Ades, MD, Cardiac Rehabilitation and Prevention, 62 Tilley Dr, South Burlington, VT 05403; e-mail: Philip.Ades@vtmednet.org

Data are presented as mean ± SD unless indicated otherwise.

Data are presented as mean ± SD. FFM = fat-free mass; H2O = water; HDL = high-density lipoprotein; LDL = low-density lipoprotein.

Data are presented as mean ± SD. FID = flow-independent dilatation (after administering nitroglycerin); FMD = flow-mediated dilatation.

DEXA = dual-energy x-ray absorptiometry; M value = insulin-stimulated glucose disposal.

a

By multivariate analysis, the only independent predictor of change in brachial artery diameter was change in body weight (R = 0.46; R = 0.19; P < .005).

For editorial comment see page 1395

Funding/Support: This study was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health [Grant RO1-HL72851 (P. A. A.)]; and the General Clinical Research Center, University of Vermont College of Medicine [Grant RR-109].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


For editorial comment see page 1395

For editorial comment see page 1395

Funding/Support: This study was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health [Grant RO1-HL72851 (P. A. A.)]; and the General Clinical Research Center, University of Vermont College of Medicine [Grant RR-109].

Funding/Support: This study was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health [Grant RO1-HL72851 (P. A. A.)]; and the General Clinical Research Center, University of Vermont College of Medicine [Grant RR-109].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1420-1427. doi:10.1378/chest.10-3289
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Background:  More than 80% of patients entering cardiac rehabilitation are overweight, with a high prevalence of associated insulin resistance, diabetes, hypertension, hyperlipidemia, and a prothrombotic state. Because each of these characteristics is associated with abnormalities of endothelial-dependent flow-mediated dilatation (FMD), a predictor of long-term prognosis in patients with coronary heart disease (CHD), we assessed the effect of exercise training and weight reduction on FMD in overweight patients with CHD.

Methods:  All patients (N = 38) participated in behavioral weight loss while taking their usual preventive medications. Subjects were randomized to one of two exercise protocols, which differed by caloric expenditure. The primary outcome was extent (%) of brachial artery FMD measured by ultrasonography before and after the 4-month exercise and weight-loss program.

Results:  Both study groups experienced an increase in brachial artery FMD after weight loss and exercise. Patients randomized to the higher-caloric exercise condition (longer-distance walking) lost more weight (8.6 ± 4.1 kg vs 2.3 ± 3.3 kg [P < .001]) and experienced a greater percentage increase in brachial artery FMD (3.6% ± 4.1% vs 1.3% ± 2.1%, P < .05) than did subjects in the lower-caloric-expenditure exercise group who lost less weight. Both groups increased peak aerobic capacity similarly. Increased FMD correlated with changes in body weight more than with measures of abdominal fat, glucose disposal, lipid measure, BP, or measures of physical activity or cardiorespiratory fitness.

Conclusions:  Exercise and weight loss increased FMD in overweight and obese patients with CHD. Greater weight reduction was associated with a greater improvement in FMD; thus, there was a dose effect.

Trial registry:  ClinicalTrials.gov; No.: NCT00628277; URL: www.clinicaltrials.gov

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