Exercise-Based Cardiac Rehabilitation Has a Strong Relationship with Mean Platelet Volume Reduction

Durmuş, İsmet; Kalaycıoğlu, Ezgi; Çetin, Mustafa; Şahin, Hanife Baykal; Kırış, Tuncay

doi:10.36660/abc.20190514

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Original Article • Arq. Bras. Cardiol. 116 (3) • Mar 2021 • https://doi.org/10.36660/abc.20190514 linkcopy

Exercise-Based Cardiac Rehabilitation Has a Strong Relationship with Mean Platelet Volume Reduction

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background Mean platelet volume (MPV), which is a simple measure of platelet activation, has recently become an interesting topic in cardiovascular research. Exercise-based cardiac rehabilitation (CR) is a comprehensive intervention that decreases mortality-morbidity in patients with coronary artery disease (CAD). Studies on the effects of exercise on platelet activation have yielded conflicting results.

Objective The purpose of this study was to determine the effect of an exercise-based CR programs on MPV in patients with stable CAD.

Methods The sample was composed of 300 consecutive stable CAD patients. The patients were divided into two groups: CR group (n = 97) and non-CR group (n = 203). Blood analysis was performed. Point-Biserial correlation measures were performed to show correlation between MPV change and CR. A p value of <0.05 was considered statistically significant.

Results The decrease in MPV was greater in the CR group than in the non-CR group [(-1.10(-1.40-(-0.90)) vs. (-0.10 (-2.00-0.00)); p< 0.001]. ΔMPV had a positive correlation with Δ neutrophil (r = 0.326, p < 0.001), ΔTG (r = 0.439, p < 0.001), ΔLDL-c (r = 0.478, p < 0.001), ΔWBC (r = 0.412, p < 0.001), and ΔCRP (r = 0.572, p < 0.001). A significant correlation was found between ΔMPV% and CR (r=0.750, p<0.001).

Conclusions We were able to show that exercise-based CR has a strong relationship with MPV reduction in patients with CAD. We consider that decreased platelet activation with exercise-based CR might play an important role in reducing thrombotic risk in patients with stable CAD. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Cardiac, Rehabilitation; Exercise; Physical, Activity; Mean Platelet Volume; Blood Platelets; Coronary artery Disease; Echocardiography/methods

Variables	non-CR group (n=97)	CR group (n=203)	p value
Age (year)	57.9±7.4	56.2±7.8	0.072
Gender (Male %)	74(76.3%)	159(78.3%)	0.399
Hypertension (n, %)	82(84.5%)	184(90.6%)	0.088
Diabetes mellitus (n, %)	20(20.6%)	55(27.1%)	0.142
Current smoker (n, %)	11(11.3%)	27(13.3%)	0.391
BMI (kg/m²)	28.2±3.1	28.3±3.9	0.885
PCI history (n, %)	61(62.9%)	117(57.6%)	0.230
ACS history (n, %)	28(28.9%)	50(24.6%)	0.259
CABG history (n, %)	19(19.6%)	37(18.2%)	0.446
LVEF %	57.1±5.3	58.3±5.6	0.086
CAD severity
1 vessel	35(36.1%)	89(44.1%)
2 vessels	58(59.8%)	98(48.5%)
>2 vessels	4(4.1%)	15(7.4%)	0.155
Gensini Score	54.1±28	50.1±28.2	0.266
ASA (n, %)	95(97.9%)	200(98.5%)	0.745
P2Y12 inhibitors (n, %)	60(61.5%)	115(56.6%)	0.493
Beta-blockers (n, %)	82(84.5%)	158(77.8%)	0.113
Calcium-channel-blockers (n, %)	42(43.3%)	91(44.8%)	0.451
RAAS inhibitors (n, %)	80(82.5%)	165(81.3%)	0.469
Statin (n, %)	92(94.8%)	197(97.5%)	0.377
Fasting plasma glucose (pre) (mg/dL)	102.6±27.1	106.2±33.7	0.307
Creatinine (pre) (mg/dl)	0.9±0.21	0.87±0.21	0.374
Hemoglobin (pre) (g/dL)	13.4±1.02	13.6±1.07	0.135
MPV (pre)	8.7±0.98	9.1±1.02	0.010
MPV (post)	8.6±0.98	7.9±0.82	<0.001
ΔMPV*	-0.10 (-2.00-0.00)	-1.10(-1.40-[-0.90])	<0.001*
ΔMPV %*	-1.15 (-2.37-0.00)	-12.63(-14.46-[-10.11])	<0.001*
ΔLDL-c (mg/dL)*	-2.00 (-1.00-0.00)	-20.00 (-36.00-[-10.00])	<0.001*
ΔTG (mg/dL)*	-9.00 (-10.50-[-1.00])	-21.00 (-49.00-[-10.00])	<0.001*
ΔHDL-c (mg/dL)*	1.00 (0.00-1.00)	4.00 (3.00-6.00)	<0.001*
ΔWBC (10³/µ³)*	0.10 (-0.25-0.30)	-0.70(-1.20-[-0.35])	<0.001*
ΔNeutrophil (10³/µ³) *	-0.10 (-0.50-0.03)	-0.80 (-1.50-[-0.39])	<0.001*
ΔCRP (mg/dL) *	-0.10 (-0.10-0.10)	-0.80 (-1.80-[-0.40])	<0.001*

	ΔMPV
	r	p value
Δneutrophil	0.326	<0.001
ΔLDL-c	0.478	<0.001
ΔWBC	0.412	<0.001
ΔCRP	0.572	<0.001
ΔTG	0.439	<0.001
LVEF	-0.133	0.021
hemoglobin (pre)	-0.139	0.019
fasting plasma glucose (pre)	-0.129	0.026
ΔHDL-c	-0.537	<0.001
CR	0.750	<0.001
age	0.034	0.563
BMI	-0.022	0.727

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[TFN1001] Data are presented as mean ± standard deviation or number of patients and percentage of patients. CR: cardiac rehabilitation; Δ: delta; BMI: body mass index; PCI: percutaneous coronary intervention; ACS; acute coronary syndrome; CABG: coronary artery bypass graft; LVEF: left ventricular ejection fraction; CAD: coronary artery disease; ASA: acetylsalicylic acid; RAAS: rennin-angiotensin-aldosterone; MPV: mean platelet volume; LDL: low density lipoprotein; TG: Triglycerides; HDL: high density lipoprotein; WBC: white blood cell; CRP: C-reactive protein; pre: before CR. *Comparison by Mann-Whitney U test at p<0.05. Values were described as medians with inter-quartile range (25^th and 75^th percentile).