Clin Res Cardiol 98, Suppl 1, April 2009

V1613 - Effects of physical exercise vs. rosiglitazone on endothelial function in CAD patients with prediabetes
S. Desch1, M. Sonnabend1, J. Niebauer2, S. Sixt3, S. Erbs1, M. Blüher4, G. C. Schuler1
1Klinik für Innere Medizin/Kardiologie, Herzzentrum der Universität Leipzig, Leipzig; 2Universitätsinstitut für präventive und rehabilitative Sportmedizin, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich; 3Kardiologie, Herz-Zentrum Bad Krozingen, Bad Krozingen; 4Medizinische Klinik und Poliklinik III, Universität Leipzig, Leipzig;
Background: Endothelial function is considered an important therapeutic target for cardiovascular interventions. Patients with coronary artery disease (CAD) and alterations in glucose metabolism typically display a state of marked endothelial dysfunction. Regular physical exercise has been shown to reduce mortality in CAD patients, can slow the progression from prediabetes to overt diabetes mellitus and exerts beneficial effects on the endothelium. There is accumulating evidence that the oral antidiabetic rosiglitazone has antiatherogenic and antiinflammatory effects independent of its effect on glucose metabolism. The aim of this study was to prospectively assess the benefits of either treatment with rosiglitazone or physical exercise on endothelial function in patients with coronary artery disease and impaired fasting glucose or impaired glucose tolerance.
Methods: We conducted a parallel-group, randomized, controlled trial to evaluate the effects of rosiglitazone and physical exercise on endothelial function in patients with coronary artery disease and prediabetes over a 6-month period. The primary endpoint was the between-group difference in flow-mediated dilation of the brachial artery. Eligible patients were randomly assigned to one of three treatment groups for 6 months: Group A received rosiglitazone tablets (Avandia, GlaxoSmithKline) 4 mg daily (n=16), group B underwent a structured physical exercise program (n=15), group C served as a control group (n=12).
Patients assigned to the physical exercise arm underwent a structured one-week in-hospital exercise program. Thereafter, patients would take part in an intense exercise program with daily home-based sessions on a stationary bicycle (30 minutes each at 75% of the maximum heart rate) and additional supervised group exercise sessions twice a week.
At baseline and after 6 months, longitudinal brachial artery ultrasound imaging was performed to assess reactive flow-mediated dilation.
Results: 42 patients completed the trial.
Baseline characteristics were similar between groups. There were no reported adverse events during the follow-up period.
No significant differences in metabolic parameters could be detected at 6 months between groups (as measured by fasting glucose, 2-hour glucose on OGTT, HbA1c, LDL, HDL, triglycerides and body mass index). Blood pressure remained unchanged.
In the exercise group, a significant improvement in VO2 max could be observed (21,7 to 23,7 ml/min/kg, p=0,009 vs. baseline) whereas control patients showed a decline in VO2 max (19,3 to 17,4 ml/min/kg, p=0,028 vs. baseline). Between-group comparisons after 6 months showed a significantly higher peak oxygen uptake in exercise patients compared to patients taking rosiglitazone and control patients.
FMD improved significantly in physical exercise patients (9,7 to 14,1%, p=0,047 vs. baseline) whereas no change could be observed in patients receiving rosiglitazone or in the control group. Between-group comparisons also showed a significant relative improvement in FMD in exercise patients compared to rosiglitazone (14,1% vs. 8,7%, p= 0,027) or control patients (14,1% vs. 7,5%, p= 0,01).
Conclusion: This study shows that physical exercise improves peripheral endothelial function in patients with CAD and prediabetes whereas no change was observed with rosiglitazone treatment or in control patients.