The aim of the present study was therefore to investigate the effect of exercise training on cIMT progression in patients with the combination of type 2 diabetes and CAD. Not many studies have investigated effects of exercise on cIMT or other measures of atherosclerosis in patents with both type 2 diabetes and CAD, and whether exercise has beneficial effect on the progression of atherosclerosis beyond up-to-date medical treatment in these patients is not clear. Dyslipidemia and alterations in reverse cholesterol transfer, partly on genetic basis, may contribute to this. Patients with type 2 diabetes have increased cIMT and their atherosclerotic disease is more accelerated and widespread compared to non-diabetic patients. In patients with known CAD, previous studies with lifestyle and exercise interventions have shown attenuated progression of coronary atherosclerosis, although more recent exercise trials have indicated less anti-atherosclerotic effect of exercise in patients on statin treatment. Physical activity over long time may protect against atherosclerosis in healthy individual, and in type 2 diabetes exercise and lifestyle intervention may improve cardiovascular risk factors and attenuate cIMT progression. Previous studies in patients with type 2 diabetes have shown reduced progression of cIMT after treatment of cardiovascular risk factors like hyperglycemia and hypertension, and changes in cIMT have been associated with changes in HbA1c. showed that the progression of cIMT in patients with established CAD was predictive of coronary events and argued that cIMT changes in these patients reflected their underlying atherosclerotic progression. cIMT has also been used as a surrogate marker of generalised atherosclerosis and studies have shown associations between cIMT and the extent of atherosclerosis in the coronary arteries. Several studies have shown associations between cIMT and the risk for future cardiovascular events in both healthy individuals, patients with type 2 diabetes and patients with known coronary artery disease (CAD). However, in patients without identified carotid plaques, beneficial effect of exercise training on cIMT progression was demonstrated.Ĭarotid intima-media thickness (cIMT) is an established marker of cardiovascular risk. One year of exercise training in patients with type 2 diabetes and CAD did not significantly change cIMT progression. However, there was a significant interaction between the effect of exercise training and the presence of carotid plaques (p = 0.013), and significant reduced cIMT was demonstrated in the exercise group compared with controls in patients without identified carotid plaques (n = 65). In the total population no difference in changes of cIMT from baseline to 12 months was observed between the exercise group and controls. Differences in changes between the randomized groups were calculated by one-way ANCOVA.
The CCA and the carotid bulb were scanned for the presence of atherosclerotic plaques. High-resolution ultrasonography of the distal part of the common carotid artery (CCA) was performed to measure cIMT before and after the intervention.
The 12 month exercise program contained 150 min weekly of combined aerobic and resistance training. Patients with type 2 diabetes and CAD (n = 137) were randomized to exercise training or standard follow-up. We investigated the effect of exercise on cIMT progression in patients with both type 2 diabetes and coronary artery disease (CAD). Carotid intima-media thickness (cIMT) holds prognostic information for future cardiovascular disease and is associated with the extent of coronary atherosclerosis.
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