Vascular Function and Inflammation in Rheumatoid Arthritis: the Role of Physical Activity

School of Sport Performing Arts and Leisure, University of Wolverhampton, Walsall, West Midlands, United Kingdom.
The Open Cardiovascular Medicine Journal 03/2010; 4(2):89-96. DOI: 10.2174/1874192401004020089
Source: PubMed


Inflammation disturbs biochemical pathways involved in homeostasis of the endothelium. Research has established clear links between inflammatory mediators, particularly C-reactive protein and tumour necrosis factor alpha, endothelial dysfunction, and atherosclerosis. Endothelial dysfunction and atherosclerosis may be subclinical at early stages, and thus the ability to detect them with non-invasive techniques is crucially important, particularly in populations at increased risk for cardiovascular disease, such as those with rheumatoid arthritis. This may allow the identification of interventions that may reverse these processes early on. One of the best non-pharmacological interventions that may achieve this is physical activity. This review explores the associations between inflammation, endothelial dysfunction, and atherosclerosis and discusses the role of exercise in blocking specific pathways in the inflammation, endothelial dysfunction - atherosclerosis network.

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Available from: Antonios Stavropoulos-Kalinoglou,
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    • "In our study, the NEAT score was significantly and negatively correlated with baPWV as the clinical marker for atherosclerosis in current smokers. Physical activity has been reported to improve the vascular endothelial function [30,31] and reduce oxidative stress and low-grade inflammation [32], which may partially explain a negative correlation between the NEAT score and baPWV. However, it remains unknown why this association between the NEAT score and PWV was not found in ex- and non-smokers, which requires further study. "
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    ABSTRACT: Background Non-exercise activity thermogenesis (NEAT) is the energy expenditure due to physical activities besides active sports-like exercise and resistance training in daily life. Methods We studied 45 subjects (22 women and 23 men) with type 2 diabetes who did not take any hypoglycemic, anti-hypertensive, or cholesterol-lowering agents and asked them about physical activity concerned with NEAT using an original questionnaire modified from a compendium of physical activities. We studied the association of the NEAT score to body weight, waist circumference, blood pressure, glucose and lipid metabolism, and arterial stiffness. Results The NEAT score was negatively correlated with serum insulin levels (r = -0.42, P < 0.05) in all subjects. The NEAT score was also negatively correlated with waist circumference (r = -0.509, P < 0.05) and positively correlated with high-density lipoprotein-cholesterol levels (r = 0.494, P < 0.05) in women, and negatively associated with serum insulin levels (r = -0.732, p < 0.005), systolic (r = -0.482, P < 0.05) and diastolic blood pressure (r = -0.538, P < 0.05) in patients with abdominal obesity. Furthermore, the NEAT score was negatively associated with pulse wave velocity (r = -0.719, P < 0.005) in smokers. Conclusion The study demonstrated that NEAT is associated with amelioration in insulin sensitivity, waist circumference, high-density lipoprotein-cholesterol, blood pressure and the marker for atherosclerosis in patients with type 2 diabetes.
    Diabetology and Metabolic Syndrome 05/2013; 5(1):26. DOI:10.1186/1758-5996-5-26 · 2.17 Impact Factor
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    • "It forms an important part of the vasculature as it represents the principal regulator of vascular function through the maintenance of vascular tone and through the release of a variety of vasoactive factors, hormones and neurotransmitters which affect vascular permeability, migration of leucocytes and inflammation. The balanced production of the vasoactive substances is atheroprotective via the regulation of fibrinolysis and coagulation, whereas a damaged endothelium causes disrupted production with the ensuing imbalance resulting in endothelial dysfunction, an early marker of atherosclerosis [34]. "
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    ABSTRACT: The last few decades have witnessed an increased life expectancy of patients suffering with systemic rheumatic diseases, mainly due to improved management, advanced therapies and preventative measures. However, autoimmune disorders are associated with significantly enhanced cardiovascular morbidity and mortality not fully explained by traditional cardiovascular disease (CVD) risk factors. It has been suggested that interactions between high-grade systemic inflammation and the vasculature lead to endothelial dysfunction and atherosclerosis, which may account for the excess risk for CVD events in this population. Diminished nitric oxide synthesis-due to down regulation of endothelial nitric oxide synthase-appears to play a prominent role in the imbalance between vasoactive factors, the consequent impairment of the endothelial hemostasis and the early development of atherosclerosis. Asymmetric dimethylarginine (ADMA) is one of the most potent endogenous inhibitors of the three isoforms of nitric oxide synthase and it is a newly discovered risk factor in the setting of diseases associated with endothelial dysfunction and adverse cardiovascular events. In the context of systemic inflammatory disorders there is increasing evidence that ADMA contributes to the vascular changes and to endothelial cell abnormalities, as several studies have revealed derangement of nitric oxide/ADMA pathway in different disease subsets. In this article we discuss the role of endothelial dysfunction in patients with rheumatic diseases, with a specific focus on the nitric oxide/ADMA system and we provide an overview on the literature pertaining to ADMA as a surrogate marker of subclinical vascular disease.
    International Journal of Molecular Sciences 12/2012; 13(10):12315-35. DOI:10.3390/ijms131012315 · 2.86 Impact Factor
    • "Inactivity has been shown to be associated with loss of lean mass, increases in fat mass and metabolic syndrome [6,7], contributing to CVD risk. Several studies do show that physically inactive patients with RA have a significantly worse CVD risk profile compared with physically active patients [8,9]. Conversely, patients with RA with high levels of physical activity (PA) (mean 3342 METhours/week) were shown to have a significantly better CVD risk profile than those with low levels of PA (mean 249 METhours/week), even when adjusting for RA disease duration, activity and severity and steroid use [10]. "
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    ABSTRACT: Background Although the general assumption is that patients with rheumatoid arthritis (RA) have decreased levels of physical activity, no review has addressed whether this assumption is correct. Methods Our objective was to systematically review the literature for physical activity levels and aerobic capacity (VO2max). in patients with (RA), compared to healthy controls and a reference population. Studies investigating physical activity, energy expenditure or aerobic capacity in patients with RA were included. Twelve studies met our inclusion criteria. Results In one study that used doubly labeled water, the gold standard measure, physical activity energy expenditure of patients with RA was significantly decreased. Five studies examined aerobic capacity. Contradictory evidence was found that patients with RA have lower VO2max than controls, but when compared to normative values, patients scored below the 10th percentile. In general, it appears that patients with RA spend more time in light and moderate activities and less in vigorous activities than controls. Conclusion Patients with RA appear to have significantly decreased energy expenditure, very low aerobic capacity compared to normative values and spend less time in vigorous activities than controls.
    BMC Musculoskeletal Disorders 10/2012; 13(1):202. DOI:10.1186/1471-2474-13-202 · 1.72 Impact Factor
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