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Dalçóquio TF, Alves Dos Santos M, Silva Alves L, Bittar Brito Arantes F, Ferreira-Santos L, Pinto Brandão Rondon MU, Furtado RHM, Gehlen Ferrari A, Genestreti Rizzo PR, Salsoso R, Franci A, Moreira Baracioli L, de Nazare Nunes Alves MJ, Negrão CE, Nicolau JC. Effects of exercise on platelet reactivity after myocardial infarction: a randomized clinical trial. Platelets 2023; 34:2139821. [PMID: 36377063 DOI: 10.1080/09537104.2022.2139821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022]
Abstract
Exercise training (ET) can lower platelet reactivity in patients with cardiovascular risk factors. However, the effects of ET on platelet reactivity in higher-risk patients is unknown. The aim of this study was to evaluate the effects of ET on platelet reactivity in patients with recent myocardial infarction (MI). Ninety patients were randomly assigned 1 month post-MI to the intervention (patients submitted to a supervised ET program) or control group. All patients were on dual antiplatelet therapy (DAPT). Platelet reactivity by VerifyNow-P2Y12 (measured by P2Y12 reaction units - PRUs) test was determined at baseline and at the end of 14 ± 2 weeks of follow-up at rest (primary endpoint), and multiplate electrode aggregometry (MEA) adenosine diphosphate (ADP) and aspirin (ASPI) tests were performed immediately before and after the maximal cardiopulmonary exercise test (CPET) at the same time points (secondary endpoints). Sixty-five patients (mean age 58.9 ± 10 years; 73.8% men; 60% ST elevation MI) completed follow-up (control group, n = 31; intervention group, n = 34). At the end of the follow-up, the mean platelet reactivity was 172.8 ± 68.9 PRUs and 166.9 ± 65.1 PRUs for the control and intervention groups, respectively (p = .72). Platelet reactivity was significantly increased after the CPET compared to rest at the beginning and at the end of the 14-week follow-up (among the intervention groups) by the MEA-ADP and MEA-ASPI tests (p < .01 for all analyses). In post-MI patients on DAPT, 14 weeks of supervised ET did not reduce platelet reactivity. Moreover, platelet reactivity was increased after high-intensity exercise (ClinicalTrials.gov: NCT02958657; https://clinicaltrials.gov/ct2/show/NCT02958657).
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Affiliation(s)
- Talia Falcão Dalçóquio
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mayara Alves Dos Santos
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Leandro Silva Alves
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Flávia Bittar Brito Arantes
- Hospital das Clinicas, Faculdade de Medicina, Universidade Federal de Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Larissa Ferreira-Santos
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Remo Holanda M Furtado
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Aline Gehlen Ferrari
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paulo Roberto Genestreti Rizzo
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rocio Salsoso
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Andre Franci
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Luciano Moreira Baracioli
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Carlos Eduardo Negrão
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - José Carlos Nicolau
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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de Almeida LB, Laterza MC, Rondon MUPB, Toschi-Dias E, de Matos LDNJ, Oliveira CC, Trevizan PF, Martinez DG. High-dose Chemotherapy Impairs Cardiac Autonomic Control of Hospitalized Cancer Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation. Clin Lymphoma Myeloma Leuk 2023; 23:e131-e138. [PMID: 36604245 DOI: 10.1016/j.clml.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/10/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Autologous hematopoietic stem cell transplantation (HSCT) patients have intermediary and late cardiac autonomic dysfunction, which is an independent mortality predictor. However, it is unknown when this HSCT-related autonomic dysfunction begins during hospitalization for HSCT and whether cardiac autonomic control (CAC) is related to cardiotoxicity in these patients. PATIENTS AND METHODS CAC was assessed in 36 autologous-HSCT inpatients (HSCT group) and 23 cancer-free outpatients (CON group) using heart rate variability analysis. The HSCT group was assessed at five time-points from admission to hospital discharge during hospitalization period. The CON group was assessed once. The severity of cardiotoxicity (CTCAE 5.0) and cardiac troponin I were recorded. RESULTS The CAC was significantly reduced after high-dose chemotherapy (HDC) (reduction of MNN, SDNN, RMSSD, LFms2 and HFnu, and increase of LFnu and LF/HF; P<0.05). At the onset of neutropenia, pNN50 and HFms2 were also reduced (P<0.05) compared to the admission ones. Although both groups were similar regarding CAC at hospital admission, the HSCT patients showed impaired CAC at hospital discharge (P<0.05). The LF/HF was positively associated with cardiac troponin I and RMSSD was inversely associated with the severity of cardiotoxicity (P≤0.05). CONCLUSION CAC worsened during hospitalization for autologous-HSCT, mainly after HDC. In addition, it seems associated to early signs of cardiotoxicity in these patients.
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Affiliation(s)
- Leonardo Barbosa de Almeida
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Juiz de Fora, Brazil.
| | - Mateus Camaroti Laterza
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Juiz de Fora, Brazil; Master´s Program on Rehabilitation Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | | | | | | | | | | | - Daniel Godoy Martinez
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Juiz de Fora, Brazil; Master´s Program on Rehabilitation Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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3
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Dalcoquio T, Santos MA, Alves LS, Arantes FBB, Ferreira-Santos L, Rondon MUPB, Alves MJNN, Furtado RHM, Ferrari AG, Genestreti PR, Reali FR, Rodriguez MRS, Franci A, Negrao CE, Nicolau JC. P331Effect of exercise stress test on platelet function in patients with recent acute myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Exercise-based cardiac rehabilitation for coronary artery disease (CAD) is associated with lower cardiovascular mortality. On the other hand, acute strenuous exercise has been linked to cardiovascular complications such as acute myocardial infarction (AMI) and sudden cardiac death. One of the pathophysiological mechanisms involved in these outcomes might be an increase in platelet aggregability after exercise. Although previous studies showed higher platelet aggregability after exercise among stable CAD patients on aspirin treatment, there is no data regarding the effect of exercise on platelet activity in post-AMI patients on dual anti-platelet therapy (DAPT).
Purpose
To evaluate the effect of high-intensity exercise on platelet aggregability in sedentary post-AMI patients on DAPT.
Methods
Platelet function was analyzed immediately before and after maximal cardiopulmonary exercise test (CPET) on cycle ergometer utilizing a personalized ramp protocol and aiming to achieving peak exercise in around 10 min. The CPET was done within 31±4 days after uncomplicated AMI. Platelet aggregability was assessed by Multiplate®ADPtest (MP-ADP) and Multiplate® ASPItest (MP-ASPI) measured as area under the curve (AUC). Reticulated platelets were measured concomitantly to MP-ADP e MP-ASPI using a fully automated flow cytometer (Sysmex XN-2000®) to determine absolute immature platelet count (IPC) per 103/microliter. Continuous variables were expressed as means ±standard deviation or as median and 25th–75th percentiles if not Gaussian distributed. Comparisons between the pre- and post-CPET assessments were performed using Wilcoxon signed rank test.
Results
We analyzed 81 sedentary patients (mean age 58.3±10.1 years-old, 76.5% men) after AMI (50.6% with ST-elevation myocardial infarction, mean left ventricular ejection fraction after index event 55±11.7%, 98.8% on statin and 85.5% on beta-blocker treatment). Platelet aggregability, either by MP-ADP or MP-ASPI, and IPC were significantly increased after CPET (table).
Platelet function after CPET Before CPET After CPET p-value Multiplate® ADPtest (AUC) – median (25th–75th percentiles) 32.0 (22.0–48.5) 37.0 (26.0–55.2) 0.003 Multiplate® ASPItest (AUC) – median (25th–75th percentiles) 17.0 (12.7–22.0) 22.0 (16.7–28.0) <0.001 Immature platelet count (103/microliter) – median (25th–75th percentiles) 9.5 (6.8–13.8) 9.6 (6.6–16.5) 0.006 CPET: cardiopulmonary exercise test; AUC: area under the curve.
Conclusion
On this post-AMI population, platelet was hyperactivated after exercise stress test despite the use of DAPT. These findings suggest that, even when properly treated, post-AMI patients might be at higher risk of ischemic complications after high-intensity exercises, reinforcing the importance of tailoring exercise prescription in this population.
Acknowledgement/Funding
Sao Paulo Research Foundation, FAPESP
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Affiliation(s)
- T Dalcoquio
- Instituto do Coracao (InCor) Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
| | - M A Santos
- Instituto do Coracao (InCor) Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
| | - L S Alves
- Instituto do Coracao (InCor) Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
| | - F B B Arantes
- Instituto do Coracao (InCor) Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
| | - L Ferreira-Santos
- Instituto do Coracao (InCor) Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
| | - M U P B Rondon
- Instituto do Coracao (InCor) Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
| | - M J N N Alves
- Instituto do Coracao (InCor) Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
| | - R H M Furtado
- Instituto do Coracao (InCor) Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
| | - A G Ferrari
- Instituto do Coracao (InCor) Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
| | - P R Genestreti
- Instituto do Coracao (InCor) Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
| | - F R Reali
- Instituto do Coracao (InCor) Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
| | - M R S Rodriguez
- Instituto do Coracao (InCor) Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
| | - A Franci
- Instituto do Coracao (InCor) Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
| | - C E Negrao
- Instituto do Coracao (InCor) Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
| | - J C Nicolau
- Instituto do Coracao (InCor) Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
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Drager LF, Lorenzi-Filho G, Cintra FD, Pedrosa RP, Bittencourt LRA, Poyares D, Carvalho CG, Moura SMGPT, Santos-Silva R, Bruin PFCD, Geovanini GR, Albuquerque FN, Oliveira WAAD, Moreira GA, Ueno LM, Nerbass FB, Rondon MUPB, Barbosa ERF, Bertolami A, Paola AAVD, Marques BBS, Rizzi CF, Negrão CE, Uchôa CHG, Maki-Nunes C, Martinez D, Fernández EA, Maroja FU, Almeida FR, Trombetta IC, Storti LJ, Bortolotto LA, Mello MTD, Borges MA, Andersen ML, Portilho NDP, Macedo P, Alves R, Tufik S, Fagondes SC, Risso TT. 1º Posicionamento Brasileiro sobre o Impacto dos Distúrbios de Sono nas Doenças
Cardiovasculares da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol 2018; 111:290-340. [PMID: 30335871 DOI: 10.5935/abc.20180154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Rodrigo P Pedrosa
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) - Universidade de Pernambuco, Recife, PE - Brasil
| | | | - Dalva Poyares
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Denis Martinez
- Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre, RS - Brasil
| | | | | | | | | | - Luciana J Storti
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
| | | | | | | | | | | | - Paula Macedo
- Hospital de Base do Distrito Federal, Brasília, DF - Brasil.,Hospital do Coração do Brasil, Brasília, DF - Brasil
| | - Rosana Alves
- Fleury Medicina e Saúde, Rio de Janeiro, RJ - Brasil
| | - Sergio Tufik
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
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Sarmento ASO, Antunes-Correa LM, Alves MJNN, Bacurau AVN, Fonseca KCB, Pessoa FG, Trombetta IC, Rondon MUPB, Ramires FJA, Brasileiro-Santos MS, Brum PC, Mady C, Negrao CE, Thomas S, Ianni BM. P5681Effects of exercise training on cardiovascular autonomic modulation and skeletal muscle tissue in chagasic cardiopathy patients and preserved systolic function. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A S O Sarmento
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - L M Antunes-Correa
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - M J N N Alves
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - A V N Bacurau
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - K C B Fonseca
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - F G Pessoa
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - I C Trombetta
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - M U P B Rondon
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - F J A Ramires
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - M S Brasileiro-Santos
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - P C Brum
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - C Mady
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - C E Negrao
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - S Thomas
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - B M Ianni
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
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Amorim Belo Nunes R, Pereira Barroso L, da Costa Pereira A, Pinto Brandão Rondon MU, Negrão CE, Krieger JE, Mansur AJ. Alpha2A-adrenergic receptor and eNOS genetic polymorphisms are associated with exercise muscle vasodilatation in apparently healthy individuals. Int J Cardiol Heart Vasc 2016; 13:14-18. [PMID: 28616554 PMCID: PMC5454168 DOI: 10.1016/j.ijcha.2016.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 09/22/2016] [Accepted: 10/07/2016] [Indexed: 01/13/2023]
Abstract
PURPOSE Muscle vasodilatation during exercise has been associated with cardiovascular health and may be influenced by genetic variability. The purpose of this study was to evaluate functional genetic polymorphisms of physiologic pathways related to the regulation of the cardiovascular function (alpha-adrenergic receptors, endothelial nitric oxide synthase and bradykinin B2 receptor) and exercise muscle vasodilatation in apparently healthy men and women. METHODS We enrolled 689 individuals without established cardiovascular disease that had attended a check-up program. The vasodilatation was studied with venous occlusion plethysmography and determined by the increase of vascular conductance during handgrip exercise. Genotypes for ADRA1A Arg347Cys (rs1048101), ADRA2A 1780 C > T (rs553668), ADRA2B Del 301-303 (rs28365031), eNOS 786 T > C (rs2070744), eNOS Glu298Asp (rs1799983) and BDKRB2 (rs5810761) polymorphisms were assessed by polymerase chain reaction followed by high resolution melting analysis. RESULTS The eNOS rs2070744 polymorphism was significantly associated with forearm vascular conductance during exercise in women. Women with CC genotype showed higher vasodilatation than carriers of TC and TT genotypes (p = 0.043). The ADRA2A rs553668 polymorphism was significantly associated with forearm vascular conductance during exercise in men. Men with TT genotype had higher vasodilatation than carriers of CT and CC genotypes (p = 0.025). CONCLUSIONS eNOS rs207074 polymorphism in women and ADRA2A rs553668 polymorphism in men were associated with the increase of forearm vascular conductance during handgrip exercise. These findings suggest that eNOS and ADRA2A genetic polymorphisms may be potential markers of exercise muscle vasodilatation.
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Affiliation(s)
- Rafael Amorim Belo Nunes
- Unidade Clínica de Ambulatório Geral, Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, Brazil
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7
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De Sá Perlingeiro P, Azevedo LF, Gomes-Santos IL, Bortolotto LA, Rondon MUPB, Negrão CE, De Matos LDNJ. Neurovascular Control and Cardiac Structure in Amateur Runners with Hypertension. Med Sci Sports Exerc 2015; 48:26-32. [PMID: 26258859 DOI: 10.1249/mss.0000000000000751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The neurovascular mechanisms underlying hypertension are minimized by exercise training. However, it is not known whether previously trained individuals with hypertension would have deleterious repercussion of this disease. Our aim was to investigate the neurovascular control and the cardiac structure of athletes with hypertension. METHODS Muscle sympathetic nerve activity (MSNA) (microneurography), baroreflex sensitivity (intravenous infusion of phenylephrine and nitroprusside), arterial stiffness (pulse wave velocity and echotracking), and cardiac structure (echocardiography) were evaluated in 17 runners with hypertension (42 ± 1 yr) and 20 normotensive (43 ± 1 yr) amateur runners. RESULTS Runners with hypertension had higher MSNA (+24% burst frequency, P = 0.02; +24%, burst incidence, P < 0.01), left ventricular mass (+22%, P < 0.01), septum wall thickness (+9%, P = 0.04), posterior wall thickness (+11%, P = 0.04), and left atrium (+11%, P < 0.001) compared with normotensive runners. Baroreflex control of heart rate was lower in runners with hypertension during increase (P = 0.05) but not during decrease (P = 0.11) of systolic blood pressure when compared with normotensive runners. There was no difference between groups in baroreflex control of MSNA during increase (P = 0.38) and decrease (P = 0.36) of diastolic blood pressure. Pulse wave velocity (P = 0.71) and carotid variables: intima media thickness (P = 0.18), diameter (P = 0.09), and distension (P = 0.79) were similar between groups. CONCLUSIONS Sympathetic overactivity seems to be involved in the underlying mechanisms of hypertension in amateur runners. Alterations in cardiac structure and decreased baroreflex control of heart rate suggest limited protection from exercise training. However, baroreflex control of MSNA and elastic properties of artery are preserved in this population.
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Affiliation(s)
- Patricia De Sá Perlingeiro
- 1Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (Incor), Medical School of University of São Paulo, São Paulo, BRAZIL; 2Hypertension Unit, Heart Institute (Incor), Medical School of University of São Paulo, São Paulo, BRAZIL; 3School of Physical Education and Sport, University of São Paulo, São Paulo, BRAZIL; and 4Hospital Israelita Albert Einstein, São Paulo, BRAZIL
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8
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Nunes RAB, Giampaoli V, de Freitas HFG, da Costa Pereira A, Araújo F, Correia GF, Rondon MUPB, Negrão CE, Mansur AJ. Exercise-Induced Muscle Vasodilatation and Treadmill Exercise Test Responses in Individuals without Overt Heart Disease. Cardiology 2014; 127:38-44. [DOI: 10.1159/000355157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/25/2013] [Indexed: 11/19/2022]
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9
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Barbosa CMG, Terra-Filho M, de Albuquerque ALP, Di Giorgi D, Grupi C, Negrão CE, Rondon MUPB, Martinez DG, Marcourakis T, dos Santos FA, Braga ALF, Zanetta DMT, Santos UDP. Burnt sugarcane harvesting - cardiovascular effects on a group of healthy workers, Brazil. PLoS One 2012; 7:e46142. [PMID: 23029413 PMCID: PMC3459900 DOI: 10.1371/journal.pone.0046142] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 08/29/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Brazil is the world's largest producer of sugarcane. Harvest is predominantly manual, exposing workers to health risks: intense physical exertion, heat, pollutants from sugarcane burning. DESIGN Panel study to evaluate the effects of burnt sugarcane harvesting on blood markers and on cardiovascular system. METHODS Twenty-eight healthy male workers, living in the countryside of Brazil were submitted to blood markers, blood pressure, heart rate variability, cardiopulmonary exercise testing, sympathetic nerve activity evaluation and forearm blood flow measures (venous occlusion plethysmography) during burnt sugarcane harvesting and four months later while they performed other activities in sugar cane culture. RESULTS Mean participant age was 31 ± 6.3 years, and had worked for 9.8 ± 8.4 years on sugarcane work. Work during the harvest period was associated with higher serum levels of Creatine Kinase - 136.5 U/L (IQR: 108.5-216.0) vs. 104.5 U/L (IQR: 77.5-170.5), (p = 0.001); plasma Malondialdehyde-7.5 ± 1.4 µM/dl vs. 6.9 ± 1.0 µM/dl, (p = 0.058); Glutathione Peroxidase - 55.1 ± 11.8 Ug/Hb vs. 39.5 ± 9.5 Ug/Hb, (p<0.001); Glutathione Transferase- 3.4±1.3 Ug/Hb vs. 3.0 ± 1.3 Ug/Hb, (p = 0.001); and 24-hour systolic blood pressure - 120.1 ± 10.3 mmHg vs. 117.0 ± 10.0 mmHg, (p = 0.034). In cardiopulmonary exercise testing, rest-to-peak diastolic blood pressure increased by 11.12 mmHg and 5.13 mmHg in the harvest and non-harvest period, respectively. A 10 miliseconds reduction in rMSSD and a 10 burst/min increase in sympathetic nerve activity were associated to 2.2 and 1.8 mmHg rises in systolic arterial pressure, respectively. CONCLUSION Work in burnt sugarcane harvesting was associated with changes in blood markers and higher blood pressure, which may be related to autonomic imbalance.
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Affiliation(s)
- Cristiane Maria Galvão Barbosa
- Pulmonary Division - Heart Institute(InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
- FUNDACENTRO, São Paulo, São Paulo, Brazil
| | - Mário Terra-Filho
- Pulmonary Division - Heart Institute(InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - André Luis Pereira de Albuquerque
- Pulmonary Division - Heart Institute(InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Dante Di Giorgi
- Hypertension Unit, Heart Institute(InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Cesar Grupi
- Electrocardiology Unit, Heart Institute(InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Carlos Eduardo Negrão
- Unit of Cardiovascular Rehabilitation and Exercise Physiology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Maria Urbana Pinto Brandão Rondon
- Unit of Cardiovascular Rehabilitation and Exercise Physiology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Daniel Godoy Martinez
- Unit of Cardiovascular Rehabilitation and Exercise Physiology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Tânia Marcourakis
- Department of Clinical and Toxicological Analyses, University of São Paulo Pharmacological Sciences School, São Paulo, Brazil
| | - Fabiana Almeida dos Santos
- Department of Clinical and Toxicological Analyses, University of São Paulo Pharmacological Sciences School, São Paulo, Brazil
| | - Alfésio Luís Ferreira Braga
- Environmental Epidemiology Study Group, Laboratory of Experimental Air Pollution, Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Environmental Exposure and Risk Assessment Group, Catholic University of Santos, Santos, São Paulo, Brazil
| | | | - Ubiratan de Paula Santos
- Pulmonary Division - Heart Institute(InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Castro RRT, Antunes-Correa LM, Ueno LM, Rondon MUPB, Negrão CE, Nóbrega ACL. Reversal of periodic breathing after aerobic training in heart failure. Eur Respir J 2010; 35:1409-11. [PMID: 20513913 DOI: 10.1183/09031936.00177209] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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11
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Cunha MR, Silva MER, Machado HA, Fukui RT, Correia MRS, Santos RF, Wajchenberg BL, Rocha DM, Rondon MUPB, Negrão CE, Ursich MJM. Cardiovascular, metabolic and hormonal responses to the progressive exercise performed to exhaustion in patients with type 2 diabetes treated with metformin or glyburide. Diabetes Obes Metab 2008; 10:238-45. [PMID: 18269639 DOI: 10.1111/j.1463-1326.2006.00690.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the effects of Metformin and Glyburide on cardiovascular, metabolic and hormonal parameters during progressive exercise performed to exhaustion in the post-prandial state in women with type 2 diabetes (T2DM). DESIGN AND METHODS Ten T2DM patients treated with Metformin (M group), 10 with Glyburide (G group) and 10 age-paired healthy subjects exercised on a bicycle ergometer up to exercise peak. Cardiovascular and blood metabolic and hormonal parameters were measured at times -60 min, 0 min, exercise end, and at 10 and 20 minutes of recovery phase. Thirty minutes before the exercise, a standard breakfast was provided to all participants. The diabetic patients took Metformin or Glyburide before or with meal. RESULTS Peak oxygen uptake (VO(2)) was lower in patients with diabetes. Plasma glucose levels remained unchanged, but were higher in both diabetic groups. Patients with diabetes also presented lower insulin levels after meals and higher glucagon levels at exercise peak than C group. Serum cortisol levels were higher in G than M group at exercise end and recovery phase. Lactate levels were higher in M than G group at fasting and in C group at exercise peak. Nor epinephrine, GH and FFA responses were similar in all 3 groups. CONCLUSION Progressive exercise performed to exhaustion, in the post-prandial state did not worsen glucose control during and after exercise. The administration of the usual dose of Glyburide or Metformin to T2DM patients did not influence the cardiovascular, metabolic and hormonal response to exercise.
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Affiliation(s)
- M R Cunha
- Laboratory of Medical Investigation LIM-18, and Endocrine Service, Hospital das Clinicas - University of São Paulo Medical School, São Paulo, Brazil.
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Cunha MR, da Silva MER, Machado HA, Fukui RT, Correa MRS, Santos RF, Wajchenberg BL, Rondon MUPB, Negrão CE, Ursich MJM. The effects of metformin and glibenclamide on glucose metabolism, counter-regulatory hormones and cardiovascular responses in women with Type 2 diabetes during exercise of moderate intensity. Diabet Med 2007; 24:592-9. [PMID: 17381497 DOI: 10.1111/j.1464-5491.2007.02117.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To compare the effects of metformin and glibenclamide on cardiovascular, metabolic and hormonal parameters during exercise of moderate intensity performed in the postprandial state, in women with Type 2 diabetes. METHODS Ten patients treated with metformin, 10 with glibenclamide and 10 control subjects (C) exercised on a bicycle ergometer at 50% of oxygen uptake (VO(2)) peak for 45 min. Cardiovascular, blood metabolic and hormonal parameters were determined at times -60 min (fasting), 0, +15, +30, +45 min (exercise) and at +60, +90 min (recovery). Thirty minutes prior to exercise, participants consumed a standard breakfast. Patients with diabetes took metformin or glibenclamide before the meal. RESULTS Systolic and diastolic blood pressure and plasma glucose were higher in both diabetic groups, for the whole experiment. Blood glucose did not change during exercise in the three groups and increased at recovery only in the control group. Plasma glucagon concentrations at the end of exercise and recovery, and plasma lactate concentrations at recovery were higher in the metformin group. Insulin, noradrenaline, growth hormone, cortisol and free fatty acid responses were similar in all three groups. CONCLUSIONS Our results suggest that the usual dose of glibenclamide and metformin can be taken safely before postprandial exercise of moderate intensity without affecting cardiovascular, metabolic and hormonal responses. However, after exercise, glibenclamide and metformin prevent the normal rise in blood glucose and metformin delays the fall in plasma lactate concentrations.
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Affiliation(s)
- M R Cunha
- Laboratory of Medical Investigation LIM-18, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.
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Tonacio AC, Trombetta IC, Rondon MUPB, Batalha LT, Kuniyoshi FHS, Laterza MC, Suzuki PH, Gowdak MMG, Barretto ACP, Halpern A, Villares SMF, Negrão CE. Effects of diet and exercise training on neurovascular control during mental stress in obese women. Braz J Med Biol Res 2006; 39:53-62. [PMID: 16400464 DOI: 10.1590/s0100-879x2006000100006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Since neurovascular control is altered in obese subjects, we hypothesized that weight loss by diet (D) or diet plus exercise training (D + ET) would improve neurovascular control during mental stress in obese women. In a study with a dietary reduction of 600 kcal/day with or without exercise training for 4 months, 53 obese women were subdivided in D (N = 22, 33 +/- 1 years, BMI 34 +/- 1 kg/m2), D + ET (N = 22, 33 +/- 1 years, BMI 33 +/- 1 kg/m2), and nonadherent (NA, N = 9, 35 +/- 2 years, BMI 33 +/- 1 kg/m2) groups. Muscle sympathetic nerve activity (MSNA) was measured by microneurography and forearm blood flow by venous occlusion plethysmography. Mental stress was elicited by a 3-min Stroop color word test. Weight loss was similar between D and D + ET groups (87 +/- 2 vs 79 +/- 2 and 85 +/- 2 vs 76 +/- 2 kg, respectively, P < 0.05) with a significant reduction in MSNA during mental stress (58 +/- 2 vs 50 +/- 2, P = 0.0001, and 59 +/- 3 vs 50 +/- 2 bursts/100 beats, P = 0.0001, respectively), although the magnitude of the response was unchanged. Forearm vascular conductance during mental stress was significantly increased only in D + ET (2.74 +/- 0.22 vs 3.52 +/- 0.19 units, P = 0.02). Weight loss reduces MSNA during mental stress in obese women. The increase in forearm vascular conductance after weight loss provides convincing evidence for D + ET interventions as a nonpharmacologic therapy of human obesity.
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Affiliation(s)
- A C Tonacio
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Azevedo LF, Brum PC, Mattos KC, Junqueira CM, Rondon MUPB, Barretto ACP, Negrão CE. Effects of losartan combined with exercise training in spontaneously hypertensive rats. Braz J Med Biol Res 2003; 36:1595-603. [PMID: 14576915 DOI: 10.1590/s0100-879x2003001100018] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We investigate whether combined treatment with losartan, an angiotensin II receptor blocker, and exercise training (ET) in spontaneously hypertensive rats (SHR) would have an additive effect in reducing hypertension and improving baroreflex sensitivity when compared with losartan alone. Male SHR (8 weeks old) were assigned to 3 groups: sedentary placebo (SP, N = 16), sedentary under losartan treatment (SL, N = 11; 10 mg kg-1 day-1, by gavage), and ET under losartan treatment (TL, N = 10). ET was performed on a treadmill 5 days/week for 60 min at 50% of peak VO2, for 18 weeks. Blood pressure (BP) was measured with a catheter inserted into the carotid artery, and cardiac output with a microprobe placed around the ascending aorta. The baroreflex control of heart rate was assessed by administering increasing doses of phenylephrine and sodium nitroprusside (iv). Losartan significantly reduced mean BP (178 16 vs 132 12 mmHg) and left ventricular hypertrophy (2.9 0.4 vs 2.5 0.2 mg/g), and significantly increased baroreflex bradycardia and tachycardia sensitivity (1.0 0.3 vs 1.7 0.5 and 2.0 0.7 vs 3.2 1.7 bpm/mmHg, respectively) in SL compared with SP. However, losartan combined with ET had no additional effect on BP, baroreflex sensitivity or left ventricular hypertrophy when compared with losartan alone. In conclusion, losartan attenuates hypertension and improves baroreflex sensitivity in SHR. However, ET has no synergistic effect on BP in established hypertension when combined with losartan, at least at the dosage used in this investigation.
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Affiliation(s)
- L F Azevedo
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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