Adherence to lifestyle modifications after a cardiac rehabilitation program and endothelial progenitor cells

Francesca Cesari; Rossella Marcucci; Anna Maria Gori; Costanza Burgisser; Sara Francini; Anna Teresa Roberts; Francesco Sofi; Gian Franco Gensini; Rosanna Abbate; Francesco Fattirolli

doi:10.1160/TH13-10-0869

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2014; 112(01): 196-204
DOI: 10.1160/TH13-10-0869

Cardiovascular Biology and Cell Signalling

Schattauer GmbH

Adherence to lifestyle modifications after a cardiac rehabilitation program and endothelial progenitor cells

A six-month follow-up study

Francesca Cesari

¹Department of Clinical and Experimental Medicine, Thrombosis Centre, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

,

Rossella Marcucci

¹Department of Clinical and Experimental Medicine, Thrombosis Centre, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

,

Anna Maria Gori

¹Department of Clinical and Experimental Medicine, Thrombosis Centre, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

²Fondazione Don Carlo Gnocchi Italia, Florence, Italy

,

Costanza Burgisser

³Geriatric Cardiology and Medicine, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

,

Sara Francini

⁴Cardiac Rehabilitation Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

,

Anna Teresa Roberts

³Geriatric Cardiology and Medicine, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

,

Francesco Sofi

¹Department of Clinical and Experimental Medicine, Thrombosis Centre, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

²Fondazione Don Carlo Gnocchi Italia, Florence, Italy

,

Gian Franco Gensini

¹Department of Clinical and Experimental Medicine, Thrombosis Centre, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

²Fondazione Don Carlo Gnocchi Italia, Florence, Italy

,

Rosanna Abbate

¹Department of Clinical and Experimental Medicine, Thrombosis Centre, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

,

Francesco Fattirolli

⁴Cardiac Rehabilitation Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

› Author Affiliations

Abstract

Summary

An increase of endothelial progenitor cells (EPCs) among acute myo-cardial infarction (AMI) patients participating in a cardiac rehabilitation (CR) program has been reported, but no data on the impact of adherence to lifestyle recommendations provided during a CR program on EPCs are available. It was our aim to investigate the effect of adherence to lifestyle recommendations on EPCs, inflammatory and functional parameters after six months of a CR program in AMI patients. In 110 AMI patients (90 male/20 female; mean age 57.9 ± 9.4 years) EPCs, high sensitivity C-reactive protein (hsCRP), N-terminal pro-brain natriuretic peptide (NT-ProBNP) levels, and cardiopulmonary testings were determined at the end of the CR (T1) and at a six-month follow-up (T2). At T2 we administered a questionnaire assessing dietary habits and physical activity. At T2, we observed a decrease of EPCs (p<0.05), of hsCRP (p=0.009) and of NT-ProBNP (p<0.0001). Patient population was divided into three categories by Healthy Lifestyle (HL) score (none/low, moderate and high adherence to lifestyle recommendations). We observed a significant association between adherence to lifestyle recommendations, increase in EPCs and exercise capacity between T1 and T2 (Δ EPCs p for trend <0.05; ΔWatt max p for trend=0.004). In a multivariate logistic regression analyses, being in the highest tertile of HL score affected the likelihood of an increase of EPC levels at T2 [OR (95% confidence interval): 3.36 (1.0–10.72) p=0.04]. In conclusion, adherence to lifestyle recommendations provided during a CR program positively influences EPC levels and exercise capacity.

Keywords

Lifestyle modifications - endothelial progenitor cells - cardiac rehabilitation - healthy lifestyle score

Full Text

References

References
1 Ades PA. Cardiac rehabilitation and secondary prevention of coronary heart disease. N Engl J Med 2001; 345: 892-902.
2 Williams MA, Ades PA, Hamm LF. et al. Clinical evidence for a health benefit from cardiac rehabilitation: an update. Am Heart J 2006; 152: 835-841.
3 Leon AS, Franklin BA, Costa F. et al. American Heart Association; Council on Clinical Cardiology (Subcommittee on Exercise Cardiac Rehabilitation Prevention) Council on Nutrition Physical Activity Metabolism (Subcommittee on Physical Activity) American association of Cardiovascular Pulmonary Rehabilitation Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2005; 111: 369-376.
4 Lawler PR, Filion KB, Eisenberg MJ. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: A systematic review and meta-analysis of randomized controlled trials. Am Heart J 2011; 162: 571-584.
5 Oldridge NB, Guyatt GH, Fischer ME. et al. Cardiac rehabilitation after myo-cardial infarction: combined experience of randomized clinical trials. J Am Med Assoc 1998; 260: 945-950.
6 Lavie CJ, Church TS, Milani RV. et al. Impact of physical activity, cardiorespira-tory fitness, and exercise training on markers of inflammation. J Cardiopulm Rehabil Prev 2011; 31: 137-145.
7 Church TS, Lavie CJ, Milani RV. et al. Improvements in blood rheology after cardiac rehabilitation and exercise training in patients with coronary artery disease. Am Heart J 2002; 143: 349-355.
8 Rauramaa R, Li G, Vaisanem SB. Dose-response and coagulation and hemos-tatic factors. Med Sci Sports Exerc 2001; 33: S516-S520. S528-S529
9 Shepard RJ, Balady GJ. Exercise as cardiovascular therapy. Circulation 1999; 99: 963-972.
10 Leitch JW, Newling RP, Basta M. et al. Randomized trial of a hospital-based exercise training program after acute myocardial infarction: cardiac autonomic effects. J Am Coll Cardiol 1997; 29: 1263-1268.
11 Berkman LF, Blumenthal J, Burg M. et al. Enhancing Recovery in Coronary Heart Disease Patients Investigators (ENRICHD) Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. J Am Med Assoc 2003; 289: 3106-3116.
12 Lavie CJ, Milani RV. Cardiac rehabilitation update 2008-biological, psychological and clinical benefits. US Cardiol 2008; 05: 72-75.
13 Hambrecht R, Fiehn E, Weigl C. et al. Regular physical exercise corrects en-dothelial dysfunction and improves exercise capacity in patients with chronic heart failure. Circulation 1998; 98: 2709-2715.
14 Laufs U, Urhausen A, Werner N. et al. Running exercise of different duration and intensity: effect on endothelial progenitor cells in healthy subjects. Eur J Cardiovasc Prev Rehabil 2005; 12: 407-414.
15 Steiner S, Niessner A, Ziegler S. et al. Endurance training increases the number of endothelial progenitor cells in patients with cardiovascular risk and coronary artery disease. Atherosclerosis 2005; 181: 305-310.
16 Adams V, Lenk K, Linke A. et al. Increase of circulating endothelial progenitor cells in patients with coronary artery disease after exercise-induced ischemia. Arterioscler Thromb Vasc Biol 2004; 24: 684-690.
17 Laufs U, Werner N, Link A. et al. Physical training increases endothelial progenitor cells, inhibits neointima formation, and enhances angiogenesis. Circulation 2004; 109: 220-226.
18 Cesari F, Marcucci R, Gori AM. et al. Impact of a cardiac rehabilitation program and inflammatory state on endothelial progenitor cells in acute coronary syndrome patients. Int J Cardiol 2013; 167: 1854-1859.
19 Van Craenenbroeck EM, Conraads VM. Endothelial progenitor cells: Focus on lifestyle. Microvasc Res 2010; 79: 184-192.
20 Sofi F, Gori AM, Marcucci R. et al. “Adherence to a healthful life attenuates lipid parameters among a healthy Italian population” Nutr Metab Cardiovasc Dis. 2007; 17: 642-648.
21 Graham I, Atar D, Borch-Johnsen K. et al. European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2007; 14 (Suppl. 02) S1-113.
22 Practice guidelines for primary care physicians: 2003 ESH/ESC Hypertension guidelines ESH/ESC hypertension guidelines committee. Hypertension. 2003 21. 1779-1186.
23 Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003 26. 5-20.
24 Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adult (Adult Treatment Panel III) final report. Circulation. 2002 106. 3143-3421.
25 Fletcher GF, Balady GJ, Amsterdam EA. et al. Exercise Standards for testing and training: a statement for Healthcare professionals from the American Heart Association. Circulation 2001; 104: 1694-1740.
26 Balady GJ, Arena R, Sietsema K. et al. Clinician’s guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation 2010; 122: 191-225.
27 Cesari F, Caporale R, Marcucci R. et al. NT-proBNP and the anti-inflammatory cytokines are correlated with endothelial progenitor cells’ response to cardiac surgery. Atherosclerosis 2008; 199: 138-146.
28 Cesari F, Nencini P, Nesi M. et al. Bone marrow-derived progenitor cells in the early phase of ischemic stroke relation with stroke severity and discharge outcome. J Cereb Blood Flow Metab 2009; 29: 1983-1990.
29 Cesari F, Sofi F, Caporale R. et al. Relationship between exercise capacity, en-dothelial progenitor cells and cytochemokines in patients undergoing cardiac rehabilitation. Thromb Haemost 2009; 101: 521-526.
30 Rawlins ML, Owen WE, Roberts WL. Performance characteristics of four automated natriuretic peptide assays. Am J Clin Pathol 2005; 123: 439-445.
31 Insner JM, Asahara T. Angiogenesis and vasculogenesis as therapeutic strategies for postnatal neovascularization. J Clin Invest 1999; 103: 1231-1236.
32 Urbich C, Aicher A, Heeschen C. et al. Soluble factors released by endothelial progenitor cells promote migration of endothelial cells and cardiac resident progenitor cells. J Mol Cell Cardiol 2005; 39: 733-742.
33 Moore MA, Hattori K, Heissig B. et al. Mobilization of endothelial and hemato-poietic stem and progenitor cells by adenovector-mediated elevation of serum levels of SDF-1, VEGF, and angiopoietin-1. Ann NY Acad Sc 2001; 938: 36-45.
34 Hattori K, Heissig B, Tashiro K. et al. Plasma elevation of stromal cell-derived factor-1 induces mobilization of mature and immature hematopoietic progenitor and stem cells. Blood 2001; 97: 3354-3360.
35 Möbius-Winkler S, Höllriegel R, Schuler G, Adams V. Endothelial progenitor cells: implications for cardiovascular disease. Cytometry Part A 2009; 75A: 25-37.
36 Aicher A, Heeschen C, Mildner-Rihm C. et al. Essential role of endothelial nitric oxide synthase for mobilization of stem and progenitor cells. Nat Med 2003; 09: 1370-1376.
37 Muller-Ehmsen J, Braun D, Schneider T. et al. Decreased number of circulating progenitor cells in obesity: beneficial effects of weight reduction. Eur Heart J 2008; 29: 1560-1568.
38 Heida NM, Muller JP, Cheng IF. et al. Effects of obesity and weight loss on the functional properties of early outgrowth endothelial progenitor cells. J Am Coll Cardiol 2010; 55: 357-367.
39 Foo SY, Heller ER, Wykrzykowska J. et al. Vascular effects of a low-carbohydrate high-protein diet. Proc Natl Acad Sci USA 2009; 106: 15418-15423.
40 Marin C, Ramirez R, Delgado-Lista J. et al. Mediterranean diet reduces en-dothelial damage and improves the regenerative capacity of endothelium. Am J Clin Nutr 2011; 93: 267-274.
41 Fernandez JM, Rosado-Alverez D, Da Silva Grigoletto ME. et al. Moderate-to-high-intensity training and a hypocaloric Mediterranean diet enhance endothe-lial progenitor cells and fitness in subjects with the metabolic syndrome. Clin Sci 2001; 123: 361-373.
42 Michaud SE, Dussault S, Haddad P. et al. Circulating endothelial progenitor cells from healthy smokers exhibit impaired functional activities. Atherosclerosis 2006; 187: 423-432.
43 Kotseva K, Wood D, De Backer G. et al. EUROASPIRE Study Group Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. Lancet 2009; 373: 929-940.
44 Kondo T, Hayashi M, Takeshita K. et al. Smoking cessation rapidly increases circulating progenitor cells in peripheral blood in chronic smokers. Arterioscler Thromb Vasc Biol 2004; 24: 1442-1447.
45 Giannuzzi P, Temporelli PL, Marchioli R. et al. GOSPEL Investigators Global secondary prevention strategies to limit event recurrence after myocardial infarction: results of the GOSPEL study, a multicenter, randomized controlled trial from the Italian Cardiac Rehabilitation Network. Arch Intern Med 2008; 168: 2194-2204.